Ant in Ear

A 12-year-old male, the son of a pediatrician, complains of something tickling his ear. The patient has no history of ear infections or trauma. He had been playing out in the yard. The image of the patient’s right ear is shown. What’s the next step in management?

1. Urgent consult to otolaryngology (ENT)
2. Foreign body removal with forceps
3. Watchful waiting with careful return instructions
4. Flush the foreign body using a syringe

Answer D. Flush the foreign body using a syringe The child has a live ant in his external auditory canal (EAC). The sensation of a bug moving in the EAC is distressing. For patient comfort, the foreign body needs to be removed. A consult to ENT without first trying to remove the object in the clinic would not be appropriate. Trying to grab a moving object with a forceps would be difficult. It is also likely to lead to ant debris in the canal. The best answer is flushing the foreign body using a syringe. That was done in this case, and the ant was easily removed. It’s unknown if the ant survived the procedure. Foreign bodies in the ear canal are common. Examples include flies, tic tacs, pencils, spiders, beans, and beads. The removal technique depends on the type of foreign body. Common techniques include flushing, forceps, Katz extractor, glue stick, and suction. With pediatric patients, the clinician generally has one chance to remove the foreign body before the patient becomes uncooperative and sedation is required. A benefit of the Wispr digital otoscope is the ability to visualize the foreign body and plan for the best removal technique.

WiscMed thanks Dr. Neil Cella of Care Point Health Care for this interesting case.