Irrigation for Ear Foreign Body Removal
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May lodge the object deeper in the canal, for which surgical intervention is required
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If expandable, irrigation could cause the object to expand
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Irrigation is uncomfortable for the patient
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Otoscope or light source and aural speculum
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Ear irrigation fluid collection cup or emesis basin
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Absorbent pad, towel, or barrier drape
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Device options:
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Large syringe with single-use otic tip
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Commercially available ear lavage system with a single-use otic tip and low pressure (do not use high-pressure)
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Irrigation solution: Lukewarm tap water
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Consider having the patient in a sitting position or semi-reclined with their head supported and turned toward the affected ear
General Considerations
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Advise the patient not to move their head during the procedure
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For a patient who is 3 years old or younger, gently pull the pinna down and back, to straighten the canal before inserting the otoscope
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For a patient who is older, gently pull the pinna up and back before inserting the otoscope
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Stop the procedure if the patient experiences dizziness or pain
Irrigation
Irrigation is done only if there are no contraindications. Contraindications include tympanostomy tube, acute or chronic tympanic membrane perforation, history of tympanoplasty, possible expandable or metallic foreign body, major otologic surgery within the past three months, or trauma
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Drape the patient with a towel(s) to create a barrier for the irrigation solution, or ask a family member to remove the patient's shirt
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Inform the patient that irrigation will cause a loud noise
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Fill the syringe with irrigation solution. Use lukewarm tap water. Avoid cold water to minimize the risk of dizziness, nystagmus, and nausea
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Insert the single-use otic tip approximately 0.5 cm into the canal and not beyond the hair-bearing skin that defines the cartilage-bone junction
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Have the patient or family member hold the ear irrigation fluid collection cup snugly under the ear to catch the irrigation solution
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Direct a low-pressure stream of water to the edge of the object and attempt to gently force the fluid behind it, as this will allow the object to be propelled out of the ear canal
If ear foreign body was successfully removed:
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Re-examine the ear canal and tympanic membrane
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If the ear canal looks damaged or irritated, prescribe antibiotic drops (steroid drops are not routinely indicated unless there is a lot of inflammation in the ear canal)
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If ear canal appears normal, ear drops are not indicated
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Be sure to check both ears and nostrils to ensure there are no other foreign bodies
If unable to remove the ear foreign body:
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Refer to ENT Clinic to be seen within 1 - 2 days (urgent referral in electronic medical record. Consider recommending NPO [Children's Mercy NPO Guidelines] for clinic visit if high concern for surgical removal)
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Provide family with ENT Clinic telephone number (816.234.3040)
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Instruct patient/family to keep ear dry
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Ear drops are not recommended before the ENT appointment
References
Cantu, M. (2024). Foreign bodies of the ear, nose, airway, and esophagus. In D. M. Kamet (Ed.), Quick reference guide to pediatric care (3rd ed., pp. 481-424). American Academy of Pediatrics. https://doi-org.childrensmercy.idm.oclc.org/10.1542/9781610027137-foreign_bodies
Lotterman, S., Sutton, A. E., & Hohman, M. H. (2025, January 22). Ear foreign body removal. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459136/
These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.