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Foreign bodies are commonly found in the external auditory canal (EAC) of children and mentally impaired adults. Children commonly place small objects such as food (beans, peas, corn, seeds) or small round objects (beads, rocks, toys) in the EAC.1–4 Adults are more likely to suffer from items used to clean or scratch the ear (cotton, paper, pencil lead) and insects that crawl into the ear, especially cockroaches.3 The EAC and tympanic membrane are exquisitely sensitive and delicate.2,5 Foreign bodies in the EAC are extremely irritating to patients and, unless proper care is taken in removal, can cause injuries.

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The EAC is S-shaped and 2.5 cm long in adults.6 The lateral or distal third is cartilaginous, with thick skin; it has more hair follicles, glands, and subcutaneous tissue than the medial or proximal two-thirds, which is bony, with a thinner, more fragile layer of skin.6,7 The narrowed isthmus is located between the cartilaginous and bony portions.1,6 The canal ends medially at the tympanic membrane, which is situated obliquely to increase the surface area for carrying sound energy to the middle ear.7 The anteroinferior EAC is 0.6 mm longer than the posterosuperior portion.6 Auriculotemporal branches of cranial nerves V, VII, IX, and X and the greater auricular nerve of the cervical plexus supply sensation to the EAC.6

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All EAC foreign bodies should be removed. The need to remove the foreign body is individualized to the patient, type of foreign body, physician preference and experience, and availability of an Otolaryngologist. The only question is how quickly this must be done, who should do it, and which is the safest of available techniques. Some foreign bodies are very easily and safely removed with the equipment available in any Emergency Department. Others—due to impaction, large size, sharp edges, location in the canal, involvement of the tympanic membrane or middle ear structures, or patient age—will require removal under general anesthesia or even an approach to removal from outside the canal.1,5,8

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The most urgent indication for immediate removal is an alkaline button battery because of the extensive and severe damage it may cause in a very short time. These are most commonly found in the EAC of a young child. There are two mechanisms for the rapid destruction of surrounding tissues by the batteries. The moisture and cerumen in the EAC have a high conductivity, which causes conduction of electric current from the battery and results in localized electrical burns. Local inflammation from burns will cause a fluid exudation into the EAC. This increases the electrical conduction injury and causes the battery to begin leaking alkaline electrolyte solution, which can penetrate deeply into underlying tissues, with resultant liquefaction necrosis.2,9

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Rather than contraindications to removal, these can also be thought of as indications for referral to an Otolaryngologist for removal ...

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