Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find the Earache (Ear Pain) article more useful, or one of our other health articles.
Treatment of almost all medical conditions has been affected by the COVID-19 pandemic. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Please visit https://www.nice.org.uk/covid-19 to see if there is temporary guidance issued by NICE in relation to the management of this condition, which may vary from the information given below.
Various objects may be found, including toys, beads, stones, folded paper, cotton buds, insects or seeds. Most ear and nose foreign bodies can be removed with minimal risk of complications. Common removal methods include use of forceps, water irrigation, and suction catheter.
- Foreign bodies of the ear are relatively common.
- They are seen most often in children.
- Most older children and adults will know that there is something in their ear but sometimes a foreign body may get into the external ear canal without the patient realising.
- The patient may present with pain, deafness or discharge. Live insects may cause a buzzing in the ear.
- The appearance will vary according to the object and length of time it has been in the ear:
- An inanimate object that has been in the ear a very short time presents with no abnormal finding other than the object itself.
- Pain or bleeding may occur with objects that abrade the ear canal, from rupture of the tympanic membrane, or from the patient's attempts to remove the object.
- With delayed presentation, erythema and swelling of the canal and a foul-smelling discharge may be present.
A great deal of care is required in order not to push the object deeper into the ear canal and not to damage the ear canal. There is a high failure rate in removal of foreign bodies from the ear.
- Insects should be killed prior to removal, using 2% lidocaine.
- Remove batteries or magnets as soon as possible to prevent corrosion or burns. Do not crush a battery during removal.
- Adhesives (eg, Super Glue®) may be removed manually within 1-2 days once desquamation has occurred. Referral to an ear, nose and throat specialist is required if an adhesive is in contact with the tympanic membrane.
Methods for removal
- Forceps or hook: grasp the object with forceps, or place a hook behind the object and pull it out.
- Irrigation is often effective. Irrigation with water is contra-indicated for soft objects, organic matter or seeds (which may swell and increase the level of pain and difficulty to remove if exposed to water).
- Suction with a small catheter held in contact with the object may be effective.
- Enhancements employed in secondary care include the use of a binocular microscope and the use of skin closure glue.
Referral to an ear, nose and throat specialist
It is advisable only to have one attempt at removal in children before referring, in order to decrease the distress caused. Complications and morbidity often occur from repeated attempts at removal of the foreign body. Referral is also indicated:
- If the patient requires sedation.
- If there is any difficulty in removing the foreign body.
- If the patient is unco-operative.
- If the tympanic membrane has been perforated.
- If an adhesive is in contact with the tympanic membrane.
Further reading and references
Awad AH, ElTaher M; ENT Foreign Bodies: An Experience. Int Arch Otorhinolaryngol. 2018 Apr22(2):146-151. doi: 10.1055/s-0037-1603922. Epub 2017 Jul 14.
Heim SW, Maughan KL; Foreign bodies in the ear, nose, and throat. Am Fam Physician. 2007 Oct 1576(8):1185-9.
Ong ME, Ooi SB, Manning PG; A review of 2,517 childhood injuries seen in a Singapore emergency department in 1999--mechanisms and injury prevention suggestions. Singapore Med J. 2003 Jan44(1):12-9.
Mackle T, Conlon B; Foreign bodies of the nose and ears in children. Should these be managed in the accident and emergency setting? Int J Pediatr Otorhinolaryngol. 2006 Mar70(3):425-8. Epub 2005 Aug 24.
Lotterman S, Sohal M; Ear Foreign Body Removal
Ngo A, Ng KC, Sim TP; Otorhinolaryngeal foreign bodies in children presenting to the emergency department. Singapore Med J. 2005 Apr46(4):172-8.