Foreign Bodies of the Ears, Nose, and Throat

Foreign Bodies of the Ears, Nose, and Throat

Alyssa Hackett

Tabitha Ford


Foreign bodies of the ears, nose, and throat are common. Their incidence, potential for morbidity or mortality, and management algorithms vary greatly depending on patient age, as well as location and physical properties of the foreign object.


Approximately 44 000 ED visits are due to ear foreign bodies in the pediatric population alone, most occurring in children ages 3 to 12.1 The ear canal is the most common site, followed by the earlobe when an earring back becomes embedded under the skin.

Approach and Management

With the appropriate equipment (Figure 23.1) and visualization, the removal of an object from the ear canal is often straightforward with a compliant adult, even with concomitant edema or infection. Visualization may be adequate with a conventional otoscope, but, if available, microscopic binocular visualization is preferred.

Small Foreign Bodies

Items such as pencil lead or sand may often be removed simply by flushing the canal with water. However, irrigation should be avoided in cases: (1) where tympanic membrane rupture is suspected or tympanostomy tubes are in place; (2) when organic foreign bodies such as food particles are lodged, as the fluid may cause swelling of the foreign body; (3) a button battery is to be removed.

Larger Graspable Foreign Bodies

In adults, cotton swabs are the most common foreign body. In pediatric patients, paper is also frequently found. These are often easily removed with alligator or Tobey forceps. Caution should be used to avoid grasping a fragile object too firmly and tearing it apart. Organic objects that break apart easily may be removed by gently maneuvering a wax loop or curette behind the foreign body to pull it out.

Nongraspable Foreign Bodies

Objects with smooth surfaces may require a range of instrumentation. A loop or curette may be used to pull the object out from behind. A sharp Rosen pick may also be advantageous to poke into
the side of a semifirm object for removal (eg, an eraser), while avoiding insertion of the pick into the center of the object and pushing it deeper into the canal. Suction may also work if the object is not tightly wedged in the canal.

Live Foreign Bodies

A patient reporting the sensation of movement or abnormal noise may suggest the presence of an insect. A noninvasive removal technique may be attempted by turning off the room lights, then introducing a light source adjacent to the external ear to motivate the insect to extricate itself from the canal.2 If this fails, application of mineral oil or a lidocaine solution should first be used to euthanize the insect, followed by removal, commonly by alligator forceps or suction.


After an object is removed from the ear canal, the external auditory canal and the eardrum should be inspected for trauma and for additional foreign bodies. If there is significant trauma and/or edema, ototopical drops with either an antibiotic or antibiotic-steroid combination may be indicated. If tympanic membrane perforation is suspected, neomycin or gentamicin drops should be avoided because of their potential ototoxic effects on the inner ear via absorption through the round window membrane.

Although most ear foreign bodies present a low potential for infection or damage if removal is delayed by days to weeks, a few special circumstances warrant urgent or emergent ENT consult. Although button batteries in the ear do not cause the same tissue damage as in the nose or esophagus, they should still be promptly removed, and ENT should be consulted if emergency department (ED) provider attempts are unsuccessful. Additionally, sharp foreign bodies or those suspected to have penetrated the tympanic membrane should be removed semiurgently by ENT without attempts by an emergency medicine (EM) provider; most small perforations will heal thereafter without the need for surgical intervention. Finally, semiurgent ENT follow-up is indicated in circumstances in which removal attempts by an EM provider are unsuccessful or predicted to be difficult.

Pediatric Issues

Whereas ear foreign body removal in an adult is typically straightforward, the same procedure in a child is often a test of patience and skill. Referral to an outpatient ENT may be the best approach for many young children, because specialized tools exist to increase the chance of success on the first removal attempt, minimizing emotional trauma for the patient. Edema, trauma, or signs of infection can be treated with ototopical drops while waiting for outpatient evaluation.


An embedded foreign body of the earlobe is easily removed with local anesthesia. The foreign body may be massaged out of a weak spot in the skin or may require a small incision to facilitate removal. Oral antibiotics are indicated if there is purulence in the wound bed.


Nasal foreign bodies are usually found in children, classically presenting as unilateral rhinorrhea, often with a bad odor or purulence. The presence of the inferior and middle turbinates usually keeps the object firmly wedged in the nasal cavity, limiting migration into more vulnerable portions of the airway.

Approach and Management

Since nasal foreign bodies are almost exclusively a pediatric entity, ENT involvement is frequently advantageous. Decongestion (topical oxymetazoline or neosynephrine) and anesthesia (topical 4% lidocaine spray) facilitates nasal access, and utilization of a papoose or involvement of the parent or second assistant is almost universally necessary. Visualization is preferred with a rigid nasal endoscope, but a handheld otoscope may be adequate. Similar instrumentation is used for extraction of nasal foreign bodies as is used in the ear (Figure 23.1).

Soft Foreign Bodies

Sponges and tissue are typically best removed with alligator forceps.

Firm Foreign Bodies

Beads and other smooth objects can be removed by passing a small ring curette behind the object and moving it forward. Alternatively, the balloon of a device such as a Katz extractor (Figure 23.2) or an infant foley catheter may be advanced beyond the foreign body, then pulled out after the balloon is inflated.

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Apr 18, 2023 | Posted by in OTOLARYNGOLOGY | Comments Off on Foreign Bodies of the Ears, Nose, and Throat

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