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External Ear Obstructions

(Ear Foreign Body)

By

Bradley W. Kesser

, MD, University of Virginia School of Medicine

Reviewed/Revised Feb 2024
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Topic Resources

The ear canal may be obstructed by cerumen (earwax), scar tissue, a tumor, a foreign body, or an insect. Itching, pain, and temporary conductive hearing loss may result. Most causes of obstruction are readily apparent during otoscopic examination. Treatment is careful manual removal using adequate lighting and appropriate instruments.

Diagnosis of external ear obstructions is usually obvious based on physical examination.

Before and after attempting to remove cerumen or a foreign body from the ear canal, clinicians should consider doing a hearing assessment Hearing Loss Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss ( 1). More than 10% of people in the US have some degree of hearing loss that compromises their... read more Hearing Loss if they have the necessary equipment readily available. Hearing loss (compared with the unaffected ear) that does not improve after removal of the obstruction could indicate that the foreign body (or prior attempts to remove it) has damaged the middle or inner ear. Hearing that worsens after removal of the obstruction could indicate damage caused by the removal process. However, clinicians who cannot formally assess hearing need not defer removal of common, easily removable obstructions. An in-office tuning fork test may also document hearing status.

Cerumen

Cerumen may be pushed farther into the ear canal and accumulate during a patient's attempts to clean the ear canal with cotton swabs, resulting in obstruction or impaction. Cerumen solvents (hydrogen peroxide, carbamide peroxide, glycerin, triethanolamine, liquid docusate sodium, or mineral oil) may be used to soften very hard wax before direct removal. However, the prolonged use of these agents may lead to canal skin irritation or allergic reactions.

In general, cerumen impaction that is severe enough to prevent visualization of the eardrum should be managed by an otolaryngologist, when practical.

Cerumen can be removed by rolling it out of the ear canal with a blunt curette or loop or a small, blunt right angle hook, or by removing it with a suction tip (eg, Baron, size 5 French). Adequate lighting is essential. These methods, particularly when done by an experienced practitioner, can be quicker and safer than irrigation. Irrigation is often done in the emergency department or primary care setting and should be done carefully to avoid complications. Irrigation may also be combined with cerumenolytic agents, such as liquid docusate sodium. Irrigation is contraindicated in patients with a known tympanic membrane perforation or with a suspected infection. Water entering the middle ear through a tympanic membrane perforation may exacerbate chronic otitis media Otitis Media (Chronic Suppurative) Chronic suppurative otitis media is a persistent, chronically draining (> 6 weeks), suppurative perforation of the tympanic membrane. Symptoms include painless otorrhea with conductive hearing... read more Otitis Media (Chronic Suppurative) and cause an acute otitis media Otitis Media (Acute) Acute otitis media is a bacterial or viral infection of the middle ear, usually accompanying an upper respiratory infection. Symptoms include otalgia, often with systemic symptoms (eg, fever... read more Otitis Media (Acute) . Irrigation is also not done if patients have diabetes mellitus, immunocompromise, or certain ear canal abnormalities or have had radiation therapy to the head and neck or if patients are taking anticoagulants.

How to Remove Earwax
VIDEO

Foreign bodies in the ear

Foreign bodies are common, particularly among children, who often insert objects, particularly beads, erasers, and beans, into the ear canal. Foreign bodies may remain unnoticed until they provoke an inflammatory response, causing pain, itching, infection, and foul-smelling, purulent drainage.

In general, foreign bodies that appear easy to grasp and remove (eg, paper, an insect wing) can be removed with alligator forceps by most practitioners (1 General reference The ear canal may be obstructed by cerumen (earwax), scar tissue, a tumor, a foreign body, or an insect. Itching, pain, and temporary conductive hearing loss may result. Most causes of obstruction... read more ). However, forceps tend to push round, smooth objects (eg, beads, beans) deeper into the canal. Patients with such objects should be referred to an otolaryngologist if the object cannot be easily removed with a curette or alligator forceps. If a smooth, round foreign body is lateral to the isthmus (bony-cartilaginous junction), it should be removed by reaching behind the object with a small right-angle instrument and rolling it out. For foreign bodies medial to the isthmus, an otolaryngologist should remove the object using a microscope for guidance. Unless a microscope is used, a foreign body lying at or medial to the isthmus (the bony cartilaginous junction of the external auditory canal) is difficult to remove without injuring the delicate canal skin, tympanic membrane, or ossicular chain. Referral to an otolaryngologist is also indicated when a child is uncooperative and may require sedation or when attempts at removal are unsuccessful.

Irrigation is not recommended for removing a foreign body; hygroscopic foreign bodies (eg, beans or other vegetable matter) swell when water is added, complicating removal.

Pearls & Pitfalls

  • Irrigation is not recommended when removing a foreign body; hygroscopic foreign bodies (eg, beans or other vegetable matter) swell when water is added, complicating removal.

When a patient cannot remain still or removal is difficult, a general anesthetic or deep sedation may be needed to prevent injury to the tympanic membrane or ossicles. If manipulating a presumed foreign body results in bleeding, further attempts at removal should stop, and an otolaryngologic should be consulted immediately. Bleeding may indicate that the canal skin is lacerated or that the foreign body is actually a middle ear polyp.

Insects in the canal are most annoying while alive. Filling the canal with viscous lidocaine (or alcohol if the eardrum is intact) kills the insect, which provides immediate relief and allows the immobilized insect to be removed with forceps by grasping a wing or leg.

General reference

  • 1. Curry SD, Maxwell AK: Management of foreign bodies in the ear canal. Otolaryngol Clin North Am 56 (5):881–889, 2023. doi: 10.1016/j.otc.2023.06.002 Epub 2023 Jul 27.

Drugs Mentioned In This Article

Drug Name Select Trade
CLEAR CARE PLUS with HydraGlyde, ESKATA, HYLAMEND
Auro Ear, Auro Earache Relief, Canal + Gel , Clearcanal, Clinere, Debrox, Ear Drops, Ear Wax Removal , Ear Wax Remover, Earwax Treatment , Gly-Oxide, Murine, Oral Peroxide Antiseptic , Thera-Ear
Colace Glycerin, Fleet, Fleet Pedia-Lax, HydroGel, Introl , Lubrin, Orajel Dry Mouth, Osmoglyn, Sani-Supp
BeneHealth Stool Softner, Colace, Colace Clear, Correctol, D.O.S., DC, Diocto, Doc-Q-Lace, Docu Liquid, DocuLace, Docusoft S, DocuSol, DocuSol Kids, DOK, DOK Extra Strength, Dulcolax, Dulcolax Pink, Enemeez, ENEMEEZ Kids, Fleet Pedia-Lax, Genasoft, Kaopectate Liqui-Gels, Kao-Tin , Phillips Stool Softener, Plus PHARMA, Silace, Stool Softener , Stool Softener DC, Stool Softener Extra Strength, Sulfolax, Surfak, Sur-Q-Lax , Uni-Ease , VACUANT
Fleet, Kondremul, Liqui-Doss, Muri-Lube
7T Lido, Akten , ALOCANE, ANASTIA, AneCream, Anestacon, Aspercreme with Lidocaine, AsperFlex, Astero , BenGay, Blue Tube, Blue-Emu, CidalEaze, DermacinRx Lidocan III, DermacinRx Lidogel, DermacinRx Lidorex, DERMALID, Dologesic, Ela-Max, GEN7T, Glydo, Gold Bond, LidaFlex, LidaMantle, Lido King Maximum Strength, Lidocan, Lidocare, Lidoderm, LidoDose, LidoDose Pediatric, Lidofore, LidoHeal-90, LIDO-K , LidoLite, Lidomar , Lidomark, LidoPure, LidoReal-30, LidoRx, Lidosense 4 , Lidosense 5, Lidosol, Lidosol-50, LIDO-SORB, Lidotral, Lidovix L, LIDOZION, Lidozo, LMX 4, LMX 4 with Tegaderm, LMX 5, LTA, Lubricaine For Her, Lydexa, Moxicaine, Numbonex, ReadySharp Lidocaine, RectaSmoothe, RectiCare, Salonpas Lidocaine, Senatec, Solarcaine, SUN BURNT PLUS, Tranzarel, Xyliderm, Xylocaine, Xylocaine Dental, Xylocaine in Dextrose, Xylocaine MPF, Xylocaine Topical, Xylocaine Topical Jelly, Xylocaine Topical Solution, Xylocaine Viscous, Zilactin-L, Zingo, Zionodi, ZTlido
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