Foreign Bodies in the Ear

Definition and epidemiology

An ear canal foreign body is any object or living creature that has entered the external canal and does not come out on its own. Clinically there are three groups: inanimate inorganic objects (beads, toy parts, stones, cotton wool, paper, erasers, button batteries), organic material (seeds, pulses, corn kernels, plant fragments) and live creatures (insects and other arthropods). The type of object determines both the urgency and the method of removal.

Ear foreign bodies are commonest in young children; in large paediatric series about three quarters of patients were under 8 years old (Heim and Maughan, 2007). In a series of 117 patients from Türkiye, 53 were under 16. The commonest objects were insects (25.6%) and seeds or kernels (15.4%); beads, seeds and plastic toy parts predominated in children, and insects and cotton bud tips in adults (İlhan et al., 2014). Adults with developmental delay or cognitive impairment are also at risk (Wilson, 2025).

Symptoms and signs

Many patients have no symptoms; the object is found because the child says so, a parent notices, or at a routine examination. When symptoms are present they include fullness, reduced hearing, itching, earache (otalgia) and discharge (otorrhoea), which is often bloody (Wilson, 2025). In young children who cannot yet explain, ear pulling or irritability may be the only clue.

A live insect moving in the canal produces a very distressing noise, severe pain and fear; contact with the eardrum may trigger coughing or dizziness. Organic material swells with moisture, increasing pain and predisposing to inflammation. Objects that go unnoticed for a long time may present with foul-smelling discharge and canal inflammation that can be mistaken for otitis externa. A button battery can burn the canal skin, eardrum and surrounding tissues within a short time (Akgül et al., 2023).

Causes and risk factors

In children, curiosity and exploratory behaviour are the main factors; the child usually inserts the object or a sibling does so during play. In adults, cotton bud tips that break off, fragments of objects used to clean or scratch the ear, and earplugs are common (İlhan et al., 2014). Remnants of an ear impression taken for a hearing aid earmould are a rare cause. Insects mostly enter the canal outdoors or during sleep; in the Turkish series they were the commonest foreign body in adults (İlhan et al., 2014).

Button batteries injure tissue in a different way from other objects. The electrical current they generate and leaking alkaline contents cause liquefactive necrosis (Heim and Maughan, 2007). In an experimental ear canal model, a lithium button battery produced alkaline tissue damage within a short time, saline did not reduce the necrosis, whereas no necrosis was found at 24 hours in the model treated with acetic acid (Akgül et al., 2023). Hearing aid batteries are also button cells, so advising families with young children to store them out of reach should be part of audiological counselling.

Audiological and clinical assessment

The diagnosis is made by otoscopy, noting the type and size of the object, where it sits (the outer cartilaginous or inner bony canal), whether it touches the eardrum and whether the canal skin is injured. Because children may insert more than one object, examining the other ear and the nostrils is sensible. After removal the canal and eardrum are reassessed, as the drum may have been injured during the procedure (Schulze et al., 2002).

• Otoscopy and otomicroscopy: show where the object lies and its relation to the eardrum; objects in the bony canal or against the drum should be assessed under the microscope.
• Timing of tests: tympanometry, OAEs and insert-earphone testing are not performed while the object is in the canal, because the probe or earphone may push it deeper. Audiological assessment is planned after removal.
• Pure-tone audiometry (after removal): with a clear canal and intact eardrum, hearing is normal. A perforation gives a mild conductive loss; if bone-conduction thresholds are also reduced, ossicular or inner-ear injury should be investigated.
• Tympanometry: if the integrity of the drum is in doubt, it is done once the acute phase has passed and with the doctor’s agreement; a high ear canal volume supports a perforation.
• Vestibular symptoms: dizziness, nystagmus or sudden hearing loss after removal suggest inner-ear injury and need prompt ENT assessment.

The differential diagnosis includes earwax impaction, otitis externa, canal cholesteatoma and canal masses. Where the eardrum has been damaged, follow-up continues along the lines described for tympanic membrane perforation.

Treatment and audiological rehabilitation

The removal method depends on the type and position of the object and on how well the patient can cooperate; the decision and the procedure rest with the doctor. Removal in the clinic should be considered only if the object is directly visible and graspable and the patient can cooperate or be safely immobilised (Wilson, 2025). Techniques include forceps, curettes or hooks, suction and, in suitable cases, irrigation.

The first attempt matters most. Each failed attempt can push the object deeper, lacerate the canal skin and increase the risk of eardrum injury; repeated attempts should be avoided and the patient referred to ENT after a single unsuccessful attempt (Wilson, 2025). In a series of 698 paediatric cases, removal succeeded in 77% of attempts by emergency physicians under direct vision and 86% by otolaryngologists using the microscope. Success was lower for spherical objects, objects touching the eardrum and those present for more than 24 hours, and failed attempts were associated with complications (Schulze et al., 2002). In another paediatric series about a third of children needed a general anaesthetic (Ansley and Cunningham, 1998). In the Turkish series, 95.7% of objects were removed in clinic under the microscope and 4.3% required sedation or general anaesthesia; canal or eardrum abrasion occurred in 15.4% and perforation in 2.6% (İlhan et al., 2014).

Some situations need a specific approach. A button battery must be removed without delay, and irrigation is avoided (Heim and Maughan, 2007). Neutralising solutions such as acetic acid looked promising in experimental work on cadaveric tissue, but there is no evidence to support their use in people (Akgül et al., 2023). A live insect is killed before removal; if the eardrum is intact, mineral oil, alcohol or lidocaine can be instilled (Heim and Maughan, 2007). Oil has been reported to kill insects faster than lidocaine, and lidocaine may cause vertigo if the drum is perforated (Kroukamp and Londt, 2006). Organic material such as seeds and pulses can swell with water, so irrigation is unsuitable.

After removal, the doctor may prescribe drops for canal trauma or inflammation. Patients with a perforation, hearing loss or dizziness are followed audiologically, and follow-up is longer after button battery injury because canal stenosis may develop.

Impact on quality of life and advice

Most ear foreign bodies are treated without lasting effects; long-term problems are linked mainly to failed attempts, button batteries and deep trauma. A distressing removal can make a child anxious about later ear examinations and hearing tests. Getting the first attempt right, in suitable conditions and experienced hands, therefore matters both medically and psychologically, and audiologists should help the child gain confidence by introducing the probe and earphones before testing.

Practical advice: if you think something is in the ear, do not try to remove it with tweezers, a cotton bud or another object, as you may push it deeper. If a button battery is suspected, go to the emergency department without delay. Keep button batteries, beads and small toy parts out of young children’s reach; store hearing aid batteries in a closed container and put used ones straight into the recycling box. Rather than scolding a child who has put something in the ear, encourage them to tell you straight away, since objects found early are easier to remove.