A foreign object in the ear can cause pain and hearing loss. Usually you know if an object is stuck in your ear, but small children may not be aware of it.
If an object becomes lodged in the ear, follow these steps:
If these methods fail or the person continues to experience pain in the ear, reduced hearing or a sensation of something lodged in the ear, seek medical assistance.
See a health care provider immediately if:
If the person sees a health care provider, the next steps depend on the particular case.
See Foreign Bodies: Curious Findings, a Critical Images slideshow, to help identify various foreign objects and determine appropriate interventions and treatment options.
In adults, insects (eg, cockroaches, moths, flies, household ants) are the foreign bodies most commonly found in the ear. Rarely, other objects have been reported (eg, teeth, hardened concrete sediments, illicit drugs, plant material).Some persons from Mexico and Central America reportedly insert leaves and other plant material into their ears as a form of native remedy. Also, some adults with psychiatric disorders present to the emergency department with foreign bodies lodged in their ears as a form of self-mutilation called ear stuffing.
In children, the range of foreign bodies is extensive. Food particles (eg, candy, vegetable matter, beans, chewing gum) and other organic material (eg, leaves, flowers, cotton pieces) are commonly encountered. Inorganic objects such as small toys, beads, pencil erasers, and rocks are also common.
The ear is composed of external, middle (tympanic) (malleus, incus, and stapes), and inner (labyrinth) (semicircular canals, vestibule, cochlea) portions. The auricle and external acoustic meatus (or external auditory canal) compose the external ear. The external ear functions to collect and amplify sound, which then gets transmitted to the middle ear. The tympanic cavity (middle ear) extends from the tympanic membrane to the oval window and contains the bony conduction elements of the malleus, incus, and stapes. The primary functionality of the middle ear is that of bony conduction of sound via transference of sound waves in the air collected by the auricle to the fluid of the inner ear. The inner ear, also called the labyrinthine cavity, is essentially formed of the membranous labyrinth encased in the bony osseus labyrinth. The labyrinthine cavity functions to conduct sound to the central nervous system as well as to assist in balance.Sometimes a young child admits to putting something like a bead or a bean in his ear, or an adult witnesses the act. Sometimes the history is hidden and the child simply presents with a purulent discharge, pain, bleeding or hearing loss. Most dramatically, a patient arrives at the emergency department panic-stricken because he feels and hears a bug crawling around in his ear.
Irrigation techniques and the use of the ear curette can also be effective in removing excess cerumen from an ear canal (see above). Whenever an instrument is used in an ear canal it is a good idea to warn the patient or parents beforehand that there may be a small amount of bleeding.
There should be no delay in removing an external auditory canal foreign body when there is an obvious infection or when the foreign body is a disk batters. On contact with most tissue, this type of alkaline battery is capable of producing a liquefactive necrosis extending into deep tissues. After removal, the canal should be irrigated to remove alkalai residue. Styrofoam beads can be instantly dissolved by spraying them with a small amount of ethyl chloride. Lidocaine has been shown to make cockroaches exit the ear canal, but this may be unpleasant for the patient. On telephone consultation, patients can be instructed to use cooking or baby oil to kill an intra-aural insect, which can then be removed in a subsequent office visit.
Complications of foreign body removal include trauma to the skin of the canal, canal hematoma, otitis externa, tympanic membrane perforations, ossicular dislocations and facial nerve palsy.
Ear Foreign Body Causes
· The vast majority of objects found in ears are placed there voluntarily, usually by children, for an endless variety of reasons. A caregiver should not threaten a child when asking about this possibility, because the child may deny having put something in the ear in order to avoid punishment. This denial could easily result in a delay of its discovery and increase the risk of complications.
· Insects are well known to crawl into the ear, usually when you are asleep. Sleeping on the floor or outdoors would increase the chance of this unpleasant experience.
Ear Foreign Body Symptoms
Fortunately, most people can tell if there is something in their ear. The ear canal, where most objects get stuck, is very sensitive. The ear canal ends at the eardrum, which is also highly sensitive. The symptoms of having a foreign body in the ear largely depend on the size, shape, and substance involved.
· Occasionally, a foreign body in the ear will go undetected and can cause an infection in the ear. In this situation, you may notice ongoing infectious drainage from the ear.
· Pain is the most common symptom. If the object is blocking most of the ear canal, you may experience a decrease in hearing on that side.
· Additionally, irritation to the ear canal can also make you nauseated, which could cause you to vomit. Some people may also cough or clear their throat because of stimulation of a nerve in the ear canal that also has a branch in the throat.
· Bleeding is also common, especially if the object is sharp or if you try to remove it by sticking something else into your ear.
· One of the most distressing experiences with this problem is having a live insect in the ear. The insect's movement can cause a buzzing in the ear and may be quite uncomfortable. Fortunately, dripping mineral oilinto the affected ear will usually kill the insect. This is safe as long as you do not have a hole in your eardrum.
· Persistent pain, bleeding, or discharge from the ear could mean that the ear passages have not been completely cleared, part of the object could remain inside the ear, or an infection of the ear canal has developed. These infections generally respond well to antibiotic drops, but an exam and prescription are necessary.
· A foreign body in the ear can also damage the eardrum, which may or may not affect hearing. Because you can’t see the eardrum from the outside, an exam of the ear is recommended.
In the majority of cases, the situation of having something in your ear will not be life threatening. Usually you will have time to call your regular doctor. The urgency of the situation primarily depends on the location of the object and the substance involved.
· Button batteries commonly found in many small devices and toys can decompose enough in the body to allow the chemicals to leak out and cause a burn. Urgent removal is advised.
· Urgent removal is also recommended for food or plant material (such as beans) because these will swell when moistened.
· Urgent examination is indicated if the object is causing significant pain or discomfort, or there is significant hearing decline ordizziness.
Exams and Tests
Most objects can be seen with good lighting and a few instruments.
· Occasionally, an object is discovered accidentally when X-rays are taken for unrelated reasons. It is important to realize that many materials such as food, wood, and plastic will not be visible on a routine X-ray.
· Do not hesitate to ask your doctor to examine the entire head and neck region. It is distinctly possible that the person has multiple foreign bodies in both ears and foreign objects in the nose.
· A foreign body in the ear is anything that gets stuck in your ear canal other than earwax. Foreign bodies are usually trapped in the outer ear canal. The outer ear canal, or external auditory canal, is the tube from the opening of your ear to the eardrum. Many kinds of objects can get into the ear canal. Once an object is inside, it becomes difficult to remove because of the small size of the ear canal .
· Anything that is inserted in your ear may get stuck and cause an ear foreign body. Children may put and push things into their ears during play. These things may include food, toy pieces, beads, buttons or disk batteries. Sometimes a child may put an object into the ear of another child. In adults, ear foreign bodies are usually inserted on purpose to clean, ease irritation or control bleeding. These may include paper, cotton swabs and sponge material. Ear foreign bodies may also include insects that fly or crawl into the ear canal.
· There may be a feeling that something is in your ear. You may have ear fullness or have trouble hearing if the ear canal is blocked. Foreign bodies may also cause itching, pain, fever, redness or bleeding. Thick drainage and a foul odor may come from the affected ear. This usually happens when the object has been there for a long time and infection has set in. If the foreign body is an insect, you may feel movement or hear buzzing.
· Your doctor will take a detailed history from you, including any ear problems you may have had. It is important that your doctor knows how long the foreign body has been inside the ear. It is also important to inform your doctor if you have tried to remove the stuck object. This will give your doctor an idea of how bad the problem may be.
· With good lighting, your doctor will carefully check your ear using an otoscope. An otoscope is an instrument used to better see the inside of the ear. Your doctor may also look for other problems, such as bleeding, infection or injury. Your eardrum will also be checked for tears or holes. Your doctor may also order a hearing test.