If the object be a living insect it should be killed at once by the instillation of warm oil, rectified spirit, or chloroform. This will cause immediate relief of the intense pain and tinnitus which may have been set up by its movements against the sensitive tympanic membrane.
The methods employed for the removal of a foreign body are syringing, extraction by instruments through the external meatus, and removal by operation by making a post-auricular incision and reflecting forward the auricle.
By syringing. In the vast majority of cases syringing is successful, and therefore should always be tried except under the following conditions:—(a) If the foreign body be of such a nature that it may be driven inwards; for example, a percussion cap for a toy pistol, lying with its concavity outwards.
(b) If there be much inflammation and swelling of the walls of the external meatus, unfortunately frequently due to previous unsuccessful attempts at extraction by instruments. In such cases forcible syringing may cause considerable pain, and in addition immediate removal of the foreign body may be impossible owing to the temporary occlusion of the meatus.
Unless urgent symptoms of retention of pus behind the foreign body are present, it is wiser to wait for a few days until the inflammation has subsided, in order that the canal may become more patent and permit of a more favourable opportunity for removal of the foreign body. The auditory canal, in the meanwhile, may be mopped out two or three times a day with pledgets of cotton-wool, and a 1 in 5,000 alcoholic solution of biniodide of mercury afterwards instilled into the ear.
The method of syringing has already been described (see [p. 308]). The syringe should be a large one with its tip protected by some india-rubber tubing. The point is inserted within the meatus up against the foreign body and the stream of lotion is directed towards any chink which may exist between it and the auditory canal. It may be necessary to use many syringefuls with considerable force before the foreign body can be expelled, but the syringing should be stopped if pain or giddiness are caused.
If the foreign body cannot be removed at the first attempt, drops of rectified spirit may be instilled into the ear several times a day, provided there are no urgent symptoms. This will tend to diminish any swelling of the soft tissues of the external meatus and of the foreign body if it is a vegetable substance. The ear should again be syringed after two or three days. In many cases this will now be successful; if not, the foreign body may be moved gently with a probe (using a speculum and reflected light), great care being taken not to push it further into the auditory canal, and another attempt may be made to remove it by prolonged syringing. If this fails it may be left in situ for a still longer period, provided there are still no symptoms requiring its immediate removal. In some cases, instead of the instillation of alcohol, a 5% solution of carbolic acid in glycerine or olive oil proves more effectual.
In the case of a hard substance, repeated attempts may be made to dislodge it before resorting to further measures; but in the case of a soft vegetable substance like a pea, it must not be forgotten that moisture tends to make it swell and perhaps will necessitate almost immediate extraction by instruments.
