Proficiency at removing foreign bodies is an art, and many times it’s a matter of having the right equipment. Often, having the right equipment, or knowing what equipment works best, is the key to successful extraction of the offending object.

Ear Foreign Bodies

Foreign bodies of the external auditory canal include cotton (most common), insects, paper, beads, seeds, eraser tips, earring parts, toy parts, and button batteries. The most commonly described techniques involve grasping the object with forceps or using a curette to drag the object out of the ear canal. Irrigation is another method used to wash the object out. Irrigation should only be undertaken if the tympanic membrane is intact.

Suction extraction has been described with variable success because of the inability to form a tight seal on certain foreign bodies, as well as a lack of suction strength needed to extract the object. With any attempt at foreign body extraction, there is the risk of pushing the object farther into the canal.

• Trick of the trade #1: A Day ear hook is a useful tool for extracting many different objects, and even impacted cerumen, from the ear (see photo 1). Its thin, short, right-angle tip can navigate into small spaces. Insert the hook parallel to the ear canal and just beyond the object to be removed. Rotate the hook tip 90 degrees behind the object and withdraw. If an ear hook is unavailable, one can be fashioned by using a hemostat clamp to bend the very tip of a paper clip (see photo 2). To provide better control of the paper clip during the foreign body extraction, secure it to the end of a pen, which serves as a longer and more stable handle (see photo 3).
• Trick of the trade #2: Tissue adhesives can also be considered when extracting foreign bodies from the ear canal. Immediately after applying a tissue adhesive to the wooden end of a Q-tip, carefully insert the wooden end into the auditory canal without touching any surface except that of the foreign body. Allow the tissue adhesive to polymerize and adhere to the foreign body for 60 seconds, and pull the Q-tip and object out as a unit. This technique was successfully used to pull a rock out from the ear canal of a patient (see photo 4). (This “trick of the trade” was contributed by Dr. Tushar Kapoor and Dr. Robert Gochman of Long Island Jewish Medical Center’s department of emergency medicine.)

Nasal Foreign Bodies

Nasal foreign bodies most commonly occur in the pediatric patient. In these situations, the key to successful diagnosis and treatment is optimal visualization.