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Doctor, is there a cockroach in my ear?

Good morning and TGIF!


Today's blogpost is on the topic of foreign bodies in the ear.


What kinds of things can get stuck inside your ear? How do you go about getting them out? Is it safe to do so on your own?


Let's have a look together shall we?



Diagram of the different parts of the ear


Foreign Bodies (FBs) in the Ear ๐Ÿ‘‚ tend to get impacted in the external ear canal. Very rarely, we see penetrating FB's which puncture the ear drum and embed in the middle ear.


Thankfully most FB's are easily shaken out or flushed out with water, but others may get lodged!


Q: How do things get stuck inside the ear?

Mostly, these are introduced by children as they play with beads / LEGO/ other small objects. Children seem to have a penchant for putting such small objects into their ears and nose, perhaps as they explore the world around them.


Sometimes, such FBs are not discovered till much later in adulthood! by then sometime the FB is encased in secretions forming "rhinoliths" in the nasal passages.


Q: What are the most common foreign bodies in the ear?

This varies with the age group of the patients. In children, the most common ear foreign bodies include inanimate objects such as beads, plastic toys, pebbles, and popcorn kernels.


Endoscopic image of a foreign body lodged into the ear canal of a 4 year old child, which turned out to be a small pebble from the playground


Foreign bodies in the ear canal can be anything a child can push into his or her ear. Some of the items that are more commonly found in the ear canal can include:

  • Food

  • Insects

  • Toys

  • Buttons

  • Pieces of crayon

  • Small batteries

Some objects placed in the ear may not cause symptoms. Other objects, such as food and insects, may cause pain in the ear, redness, or drainage. Hearing capability may be affected if the object is blocking the ear canal.


Insects are more common in adults and patients older than 10 years.


Q: Why do bugs/cockroaches like to crawl into the ear?

Cockroaches and other insects like to climb in ears and may even lay eggs inside ๐Ÿ˜ณ


Sometimes, insects e.g. cockroaches tend to be attracted to the ear canal and wander in! Cockroaches especially love small, warm and humid places they consider safe, like the ear. A cockroach can move forwards INTO the ear canal, but do not know how to move backwards to LEAVE the ear canal and get stuck.


For more examples of cockroaches loving the ear, you can read these articles at The Verge, CNN, and The Straits Times.



Q: What are the common signs and symptoms of a foreign body in the ear?
  • Feeling of something inside your ear

  • Trouble hearing

  • Ear pain

  • Redness, itching, or bleeding in your ear

  • Thick drainage or a foul odour coming from your ear

  • Nausea or dizziness


Q: How can I tell if there is something in my ear that doesn't belong? What if I don't notice it?

Most times, patients present with a blocked ear or discharge when they have a FB lodged inside the ear canal. Most adults will present quite early to A & E after a FB is felt in their ears.


However, sometimes, especially in young children, these inanimate FBs may go undetected for months or even ears.


Q: What can I do if something gets lodged in my ear?

  • Know when to seek help. If there is bleeding, severe pain, drainage or signs of infection, see a health care provider right away. Also, if you know the object is a battery, seek help right away. And if you can't easily see the object and you've tried removing it more than once, stop and get care. Delays and many failed tries to remove it can lead to infection and damage.


  • Never poke or prod the object. If you use tools such as cotton swabs or matchsticks to pry an object out, they can push it deeper into the ear. This may cause more damage.


  • Use tweezers. If the object is easy to see and grasp, gently remove it with tweezers.


  • Use water. Only wash out the ear canal if you don't think there is a hole in the eardrum and no ear tubes are in place. Use a rubber-bulb syringe and warm water to wash the object out of the canal. Don't use water to remove batteries, food or plant material.


  • Use oil or alcohol for an insect. If the object is an insect, tilt the head so that the ear with the insect is upward. Pour alcohol or warm, but not hot, oil into the ear. The oil can be mineral oil, olive oil or baby oil. The insect should float out. Don't use oil if you think there is a hole in the eardrum or if ear tubes are in place. It is good to drown the live insect before any attempt is made to remove it. Otherwise the insect and the patient may get even more agitated!


  • Never use liquid if there is a hole in the eardrum or if a child has ear tubes. If you see signs of a hole in the eardrum such as pain, bleeding or discharge, see a health care provider right away.


Q: How do you treat foreign objects lodged in the ear?


The treatment for foreign bodies in the ear is prompt removal of the object by a qualified healthcare provider. The following are some of the techniques that may be used by your child's healthcare provider to remove the object from the ear canal:

  • Instruments such as long, thin tweezers or forceps may be put in the ear to grab and remove the foreign object.

  • Magnets are sometimes used to remove the object if it it is metallic.

  • The ear canal may be flushed with water. Many GP clinics have the ear syringing kit which is useful for flushing out smooth / round objects eg beads.

  • A machine with suction may be used to help suck the object out. This is more often seen in ENT clinics and hospitals.

Q: When should I seek help from an ENT Specialist to remove the foreign body?


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 a foreign body.


A referral is also indicated:

  • If the patient requires sedation.

  • If there is any difficulty in removing the foreign body.

  • If the patient is uncooperative.

  • If the tympanic membrane has been perforated.

  • If an adhesive is in contact with the tympanic membrane.

I hope you found this blogpost an interesting read and wish you a blessed Friday.


Until next time!


Dr Euan


If you would like to seek consultation or treatment for foreign bodies in the ear, or any other ENT conditions, please feel free to Contact Us at Euan's ENT Surgery & Clinic to make an appointment.


Euan's ENT Surgery & Clinic Tel No. : +65 6694 4282


References:


1.Chiun KC, Tang IP, Tan TY, Jong DE. Review of ear, nose and throat foreign bodies in Sarawak General Hospital. A five year experience. Med J Malaysia. 2012 Feb;67(1):17-20. [PubMed]


2.Ray R, Dutta M, Mukherjee M, Gayen GC. Foreign body in ear, nose and throat: experience in a tertiary hospital. Indian J Otolaryngol Head Neck Surg. 2014 Jan;66(1):13-6. [PMC free article] [PubMed]


3.Parajuli R. Foreign bodies in the ear, nose and throat: an experience in a tertiary care hospital in central Nepal. Int Arch Otorhinolaryngol. 2015 Apr;19(2):121-3. [PMC free article] [PubMed]


4.Thompson SK, Wein RO, Dutcher PO. External auditory canal foreign body removal: management practices and outcomes. Laryngoscope. 2003 Nov;113(11):1912-5. [PubMed]


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6.Marin JR, Trainor JL. Foreign body removal from the external auditory canal in a pediatric emergency department. Pediatr Emerg Care. 2006 Sep;22(9):630-4. [PubMed]


7.Falcon-Chevere JL, Giraldez L, Rivera-Rivera JO, Suero-Salvador T. Critical ENT skills and procedures in the emergency department. Emerg Med Clin North Am. 2013 Feb;31(1):29-58. [PubMed]


8.Friedman EM. VIDEOS IN CLINICAL MEDICINE. Removal of Foreign Bodies from the Ear and Nose. N Engl J Med. 2016 Feb 18;374(7):e7. [PubMed]


9.Benger JR, Davies PH. A useful form of glue ear. J Accid Emerg Med. 2000 Mar;17(2):149-50. [PMC free article] [PubMed]


10.Lou Z. The outcome and complication of endoscopic removal of pediatric ear foreign body. Int J Pediatr Otorhinolaryngol. 2021 Jul;146:110753. [PubMed]


11.Afolabi OA, Aremu SK, Alabi BS, Segun-Busari S. Traumatic tympanic membrane perforation: an aetiological profile. BMC Res Notes. 2009 Nov 21;2:232. [PMC free article] [PubMed]


12.Davies PH, Benger JR. Foreign bodies in the nose and ear: a review of techniques for removal in the emergency department. J Accid Emerg Med. 2000 Mar;17(2):91-4. [PMC free article] [PubMed]


13.Mingo K, Eleff D, Anne S, Osborne K. Pediatric ear foreign body retrieval: A comparison across specialties. Am J Otolaryngol. 2020 Mar-Apr;41(2):102167. [PubMed]


14.Prasad N, Harley E. The aural foreign body space: A review of pediatric ear foreign bodies and a management paradigm. Int J Pediatr Otorhinolaryngol. 2020 May;132:109871. [PubMed]


15.Nivatvongs W, Ghabour M, Dhanasekar G. Difficult button battery ear foreign body removal: the magnetic solution. J Laryngol Otol. 2015 Jan;129(1):93-4. [PubMed]


16.Leffler S, Cheney P, Tandberg D. Chemical immobilization and killing of intra-aural roaches: an in vitro comparative study. Ann Emerg Med. 1993 Dec;22(12):1795-8. [PubMed]


17.Oyama LC. Foreign Bodies of the Ear, Nose and Throat. Emerg Med Clin North Am. 2019 Feb;37(1):121-130. [PubMed]




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