A 23 year-old girl presented with complaints of a crawling sensation in the ear for three hours. She had been sleeping on the floor when suddenly she felt an insect enter her ear followed by a crawling sensation. On examination a live ant was seen over the tympanic membrane (Figure 1). The ant was removed by irrigating the ear with warm saline. The tympanic membrane was intact and the patient had no further complaints. The most common ear foreign bodies include beads, plastic toys, pebbles and insects. The external auditory canal narrows at the bony cartilaginous junction. Foreign bodies can become impacted at this point, increasing the difficulty of removal. Most cases may be asymptomatic, especially in children, and the foreign body may be detected incidentally. Other patients may present with pain, irritation, hearing loss or a sense of ear fullness.
The removal of the foreign body depends on the size and nature of foreign body and the experience of the physician. Options for removal include water irrigation, forceps removal and suction catheters. Live insects can be killed rapidly by instilling alcohol, 2% lidocaine, betadine paint and diluted hydrogen peroxide or mineral oil into the ear canal, however this is to be avoided in patients with perforation of tympanic membrane. Adequate visualisation, appropriate equipment, a cooperative patient and a skilled physician are the keys to successful foreign body removal.
Multiple foreign bodies are common, especially in small children and mentally challenged adults. Therefore all other orifices of the head should be inspected in these patients.
Figure 1: Endoscopic view of the external auditory canal showing the ant over the tympanic membrane.