Suddenly, out of the blue, your child complains of ear pain. No ear discharge, no fever, no hearing loss. Sounds a bit funny, so you bring him to the clinic. To your surprise, the doctor tells you he has a piece of toy in the ear. How could that happen? When did that happen? Plus tonnes of other questions which you have never expected suddenly flashed through your mind.
Foreign body in the ear is not uncommon. Usually seen more in children. There is a wide array of foreign body inserted. It can be classified as organic-inorganic, animate-inanimate, metallic-nonmetallic, hygroscopic-nonhygroscopic, regular or irregular, soft or hard, and according to their nature. The symptoms vary according to the type of foreign body as well. Methods of removal & instruments used are also determined by type of foreign body.
If the foreign body is inert- especially the plastic type, there may not be any symptom except for discomfort or pain. Unless if it is big, there may be hearing loss. The other types of foreign body will give symptoms once there is reaction to it. Live animals, usually insects, will show symptoms immediately. Adults will usually have loose cotton tip embedded in the ear, sometimes without them knowing. As I have mentioned in my previous article, there is no necessity to clean the ear & it is rather dangerous to do so.
What to do then if you have a foreign body stuck in the ear?
If you suspect it, please see a doctor whenever possible. If there are symptoms such as pain, please see urgently. If you are not sure and the child is quite alright overnight, you can wait the next day.
Image 2: Endoscopy view of the cockroach in the ear canal
If there is an insect and it is moving around- it can be very terrifying & painful. If it is a small insect (image 1) and there is no pain, you can move to a room, off the lights & make it totally dark. Switch on a flashlight, from your handphone is acceptable. Insects tend to move to a light source. If the insect is rather large and there is unbearable pain- use baby oil, olive oil or other non irritative oil to fill up the ear canal up to the brim. This will drown the insect and pain will be less once the insect stops wriggling.
What can a doctor do once he sees a foreign body in the ear?
It looks very easy & tempting to remove an object from the ear canal- it looks like a 5 second easy procedure. But trust me, it is not all that simple. I have tried many times as a junior doctor in the district hospital, failed in almost all attempts for ear foreign body cases. It is not until my training in ENT that I realized that I have done it wrongly.
Reason being:
- Most clinics & emergency departments do not possess specialized ENT equipment to remove it. This will result in more damage to the canal such as bleeding & swelling which makes further removal more difficult
- Especially in children, some may be cooperative at first and the object is easily removed. But once it fails and the child is in pain, he may not trust another doctor again to even touch him.
Usually it is safer to refer ear foreign body cases to ENT department for safe & proper removal. This is to provide a more successful removal and avoid unnecessary physical and mental trauma to kids.
We have various methods & instruments (image 2) to remove, depending on the objects.
Image 2: Instruments used for foreign body removal
Crocodile Forceps: for those with edges easily grabbed such as paper and insects
Jobson-Horn: curve like probe to roll things out of the canal such as bead
Syringing: using water jet at body temperature to flush out objects such as plastic
Suctioning: for thin objects with a wet film which can be sucked out
Most cases are usually removed safely, some with minor trauma on the ear canal skin or very rarely with perforated tympanic membrane (ear drum). Some may need to be admitted for general anaesthesia if uncooperative or too painful to be removed in clinic.
So if your kid have a foreign body in the ear, please refer them as I have mentioned. Hopefully it will be removed safely. Last note, based on my experience- history from a child with a foreign body in the ear or nose is not 100% accurate. Allow some room for lies to take place. Hopefully you can leave all the scolding and punishment after we have removed the foreign body successfully.
Dr Ahmad Nordin is an Ear Nose and Throat surgeon currently working in Sabah. Find out more about him on The Team page.
References:
- Ahmad Nasrat Al-juboori Aural Foreign Bodies: Descriptive Study of 224 Patients in Al-Fallujah General Hospital, Iraq International Journal of Otolaryngology Volume 2013 (2013) Article ID 401289
- ENT foreign bodies: profile of the cases seen at a tertiary hospital emergency care unit João Mangussi-Gomes1 , José Santos Cruz de Andrade1 , Rafaella Caruso Matos2 , Eduardo Macoto Kosugi3 , Norma de Oliveira Penido4 Brazilian Journal of Otorhinolaryngology Vol.79 no.6 São Paulo Nov./Dec. 2013
- First Aid, CPR, and AED Essentials Sixth Edition American Academy of Orthopaedic Surgeons (AAOS),, American College of Emergency Physicians (ACEP),, Alton L. Thygerson
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]