How Common Are Ear Foreign Bodies, Including Insects?

Instances involving Ear Foreign Bodies are not uncommon, with cases ranging from insects accidentally entering the ear canal to other unconventional objects finding their way inside.

If we analysed some clinical data regarding the foreign body of the ear, we would find that most of the cases which have been happening to adult population were accidental in nature while for the paediatric population, they were involved in some kind of self-experimentation to actually discover the potential of their ear to be interconnected with each other.

You know what, forget about that, most of the cases among the paediatrics were kind of intentional. Well, most of the foreign body cases kind of was, I mean if the foreign body was found in the upper respiratory tract of a child, chances are, he or she was eating it.

Regardless, the most common things which were found among the ear wax in the inside of the ear canal of an individual are inanimate objects.

Unlike what you were possibly thinking or imagining after reading an article about cockroaches, they only constitute a small percentage (4 out of 70 cases) of documented cases which were treated in a tertiary hospital (Ramesh Parajuli, 2014).

In 2009, a case report which was written by Sanjay Arora and Sandeep Kumar Goyal revealed a case of a highly unusual foreign body called beedi which stuck in the inside of the left ear of a patient with Schizophrenia.

Beedi is a thing like a cigarette, only it is a leaf-wrapped tobacco which is usually smoked and can be found mostly in India. The patient who was found to have beedi in the inside of his ear was on a long-term maintenance therapy for 1 year and it actually works for him so the notion of him, having a psychotic outbreak in the middle of treatment is relatively negligible.

The beedi might have stuck for a longer period of time, possibly before he was put on the Olanzapine treatment and only recently, he complained of a reduced hearing level on his left ear. So now, we know two reasons why foreign body stuck in the inside of an adult ear eh?

Some Cases Of People With Insects/Strange Things In The Inside Of Their Ears

Despite the conclusion made by Ramesh Parajuli, some studies, particularly the one which was recorded but not published by the John Hopkins Emergency Department in 1987, has found that the majority of foreign bodies extracted from the ear of an adult is insects (constitute around 86% out of 106 treated patients).

This study was later supported by Bressler et al in 1993, stating that out of 98 patients which were treated for foreign bodies in their ears, the most common culprits were cockroaches.

The most disturbing thing about this “cockroach-incident” is that almost half out of the 98 patients treated were found to have some sort of laceration to the wall of the ear canal signifying struggle and damage imposed by the cockroach when someone felt tempted to scratch their ear canal by using the tip of their finger or worst, a cotton bud which can possibly push them further inside, ultimately scratching the tympanic membrane (ear drum) thus otalgia (ear pain).

Enough about that, let’s see three weird things (be it an insect or an inanimate object) which have been discovered on the inside of someone’s ear:

A spider

When feeling some itchiness of either of the ears, we seem to be overly concerned with the idea of cockroaches might have been injuring the integrity of the external canal when sometimes, it can be a little (well possibly over an inch) arachnid, walking (or crawling), finding a suitable site to anchor its web.

This happens in China when a woman felt an itch that she can’t literally scratch in her left ear for a period of five days. She went to a Hospital located in Changsha for a consultation, maybe ask for some ear drop, only to feel grim by the news delivered by the treating doctor.

I can’t begin to fathom what it feels like to look through the otoscope, finding a creature which has more than 4 eyes; the doctor must be freaked, well I would!

Anyway, the question is, how to extract a living spider from its “nest” while preventing injury to the nearby structure particularly the eardrum which is considered as an important component for hearing.

Pulling the spider is probably not a good idea (do you know how many legs does a spider has?!) so the treating doctor went ahead, using a saline solution to flush the spider out without grabbing it with any kind of instruments.

It is can be quite common for a spider to crawl in but rare for them to establish the ear canal as their home.

A Flesh-Eating Maggot

It is okay to get worried if you have some kind of ear pain after a traumatic incident, swimming or someone hit you in the face with a bat. It is not okay if, without any obvious reason, or in this case, after travelling to Peru, you experience a terrible pain which felt like something tries to tear up your eardrum into two.

After getting back from Peru with her boyfriend, Rochelle (27) experienced some distressing symptoms in which, at first, she thought it was just a minor infection of her ears.

The thing about infected ears, the focus of infection is so close to the brain in which sometimes, it can progress to brain-related infections such as encephalitis and meningitis so, like any other people who treasure their health and life, she went to the Emergency department of a hospital located in the United Kingdom.

After a series of routine history taking, physical examination and radiological investigations by an ORL specialist, Rochelle was shocked when she was told that her symptoms were caused by maggots of the New World Army Screw Worm Fly which have been burrowing inside of her head through the auditory canal which caused the excruciating pain, mistaken for an ear infection.

They tried to remove it but it is a little bit tricky and every time, they try to do so, the maggot keep on going deeper and deeper into the structure. During the operation, when Rochelle consented for a procedure to remove the maggot, surgeons were shocked to find a clustered of maggots aggregating with each other.

All of the maggots were then sent to the lab and Rochelle shows no long-term complication related to having maggots who tried to screw around with her brain.

A Tooth

The next time you found a tooth inside a child’s ear, you might want to blame the tooth fairy for that. In 2012, there is a boy who was presented to a specialist clinic with a complaint of watery discharge from the nose (rhinorrhea).

He was given a few medications which are designed to treat the symptoms but after a few days, the symptom becomes profuse.

After a series of biochemical workup and radiological investigations, there were two significant findings which can be the culprit behind the profuse rhinorrhea.

The kid shows some signs which can relate to sinusitis and there seems to be some calcified structure that can be seen in the left ear canal in the CT scan; the calcified structure was then identified as a tooth.

Putting a deciduous tooth under/beside the pillow for money has been a popular practice among kids especially in the United Kingdom.

The tooth would be collected by a tooth fairy which later will leave the kid with some coins or anything that can be of an equal value for children.

I’m not sure how the value would be determined, maybe they have some sort of list to check for its current market value? The 8 years old boy claimed that the tooth fairy actually came to him, took the tooth and shove it into his left ear in which his parents reassured him that he was just dreaming.

Nevertheless, the tooth was extracted safely and the parents consented for this case to be shared for the rest of the world to learn.

I think the funniest reasons for keeping the deciduous tooth I’ve ever heard is when a man, stick his child tooth to his nipple piercing to show the act of love to his child and end up with a nipple abscess.

There is also a medical case whereby a girl who purposely inserted her own tooth in her ears for safekeeping so that she won’t lose it and it can be safely collected by the fairy tooth later. Man, fairy tooths sure are a popular job among children in the UK!

Clinical Significance of Foreign Body In The Ear

I don’t have to include cockroaches in the list above, do I? I think being freaked out once, reading an article about cockroaches is more than enough.

Nevertheless, when a foreign body was stuck inside of someone’s ear, we would have the tendency to try and scratch it out, especially when the thing is moving; for a child, they will cry as loud as they can of course.

These actions can cause more damage to the epithelial lining of the ear canal which can cause it to tear and bleed forming an inflammatory area (usually referred as the otitis externa; inflammation to the external ear) and of course, finally an infection (unless the foreign body was sterile which is highly unlikely).

Although removing foreign bodies in the clinic seems simple, some of the cases would need a controlled environment which is usually ideal for a foreign body extraction to minimise infection and other related complications such as bleeding and possibly tearing of the eardrum.

In a study conducted by Cunningham and Ainsley has found that as high as 30% of the ear foreign body removal cases need to be done under general anaesthesia.

If you are not familiar with general anaesthesia, it is basically an anaesthetic procedure which would put the patient to sleep before a surgeon would begin operating. I would cover the topic sometimes in the future.

Basically, in this case, a patient would require general anaesthesia if he/she is an uncooperative child, an anxious adult who have some psychiatric problems, a complicated case of foreign body in the ear or simply because people requested it.

Leaving the foreign body inside of the ear can lead to a few complications which are usually related to the patient’s capability to hear adequately.

In a study conducted by Singh et al in 2007, they have found that complications related to the removal of foreign bodies can be up to 80% in which they failed to mention specifically the reasons behind the high chances of complications.

According to a study conducted by Al-Juboori in 2013, the rate of complications from extracting foreign bodies of the ear was just up to 12.5% which is relatively low. The study mentioned earlier conducted by Singh et al might have been focusing on a patient who had multiple attempts at removal which increase the chances of infection or any other complications by certain factors.

However, I think we all can agree that whatever goes into the ear must come out or else.

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