Have you ever treated a patient presenting with a case of insect-in-the-ear? Understandably, the situation is quite distressing for the patient. Spiders, cockroaches, and other creepy-crawlies entering the ear canal, particularly during sleep, occurs more commonly than you might think. While this isn’t a problem I treat on a daily basis as a nurse practitioner in the emergency department, it happens from time to time. What is the best approach for removing an insect from the ear?
Step 1: Comfort Measures
As you can imagine, the sensation of a live insect wriggling around in your ear canal is quite unnerving. The first step to removing an insect from a patient’s ear is to kill the offending bug. Sorry nature lovers, it’s the only way. Not only does this give partial relief to the patient, it helps the patient remain still as you attempt to remove the foreign body.
To kill the insect, fill the ear canal with mineral oil or lidocaine. Lidocaine the ideal choice as it provides local anesthesia for the removal process.
Step 2: Extraction
There’s no single tried and true way to remove a foreign body from the ear. The method you choose should depend on the size and location of the insect and your level of expertise. Irrigation, suction, and mechanical extraction with a right angle hook or alligator forceps may all be effective methods for removing an insect from the ear. Choose an appropriate instrument based on the type of insect present. Small, light and mobile objects are among those most easily removed with suction.
Step 3: Check Your Work
Unsettling but true, insect bodies may break apart during the removal process. Visualize the ear canal after removal to make sure the entire critter has been removed. You may also consider irrigating the ear canal after extraction to remove any remaining debris.
After removing a foreign body from the ear, always reexamine the ear checking for signs of complications. Complications of foreign body removal may include abrasions, bleeding, perforation of the tympanic membrane, ossicular damage, hearing loss, vertigo, and facial nerve damage.
Step 4: Call in the Experts
The first attempt at removing a foreign body from the ear is critical. After a failed initial attempt, the chance of success at removal decreases dramatically. As more attempts are made to remove the foreign body, the risk of complications increases. As many as 30 percent of patients may require specialty referral, sedation, and/or anesthesia for removal of a foreign body from the ear.
Most foreign bodies in the ear can be removed in the clinic or emergency department however specialist referral must be considered in situations where the patient is a risk for complications or removal has failed after multiple attempts.
For those of you whose clinical practice hasn’t presented you the opportunity to treat this skin-crawling conundrum, check out the following video compilation of ear canal dwelling insects. Warning: do not view on your lunch break.
What’s the strangest thing you’ve removed from a patient’s ear?