Do not perform foreign body removal if TM perforated or perforation cannot be ruled out. Insert the otoscope into the ear canal to observe the tympanic membrane and look for the foreign body.

• Position patient in either a seated or lateral decubitus position
• Adults and young children: pull pinna superiorly and posteriorly to straighten the ear canal
• Infants: pull pinna inferiorly and posteriorly to straighten the ear canal

Considerations:
• The nature of the foreign body should help guide decision regarding chosen technique.
• Choose technique that will most likely allow successful removal of the foreign body on the first attempt.
• Irrigation is contraindicated in cases of organic material as liquid will cause the material to swell in the ear canal.
• Live insects should be immobilized with mineral oil before removal is attempted.
• Mechanical extraction can be painful and requires cooperation from the patient.
• A foreign body that might break into smaller pieces with the use of forceps may be better removed with suction or glue.

See part titled “Aural Canal Irrigation”

• Position the patient supine with the affected ear up
• Straighten the ear canal (see step 2)
• Re-examine external ear canal with otoscope to confirm presence and position of foreign body
• Gently and slowly insert either the curette or forceps
• Soft objects, insects, or those with protruding surfaces/irregular edges can be removed using the alligator or bayonet forceps
• Objects that are round or breakable, insert cerumen curette just past foreign body then carefully withdraw
• Instill mineral oil to immobilize the an insect prior to removal

• Allow patient to hear the sound of the suction beforehand to increase cooperation
•  Set suction to low (between 100 and 140mmHg)
• Straighten the ear canal (see Step 2)
• Gently place the suction tip onto object; avoid touching tip of suction catheter to canal wall
•  Begin to suction, slowly pull object out of the canal

• Apply a small amount of glue to the blunt end of the cotton-tipped handle applicator or the tip of the unfolded paper clip
• Straight the ear canal (see Step 2)
• Gently and slowly touch the tip with glue to the object (some glues may take 60 seconds to adhere to the object)
• Pull object out of the ear canal

Ensure all objects have been removed and reassess condition of tympanic membrane.

• Consider nature of the patient and health history; if abrasion or laceration resulted during removal of the foreign body provide topical antibiotic ear drops
• Minor abrasions typically heal without complications