Removal of a Bee from the Ear
A bee in the ear should be killed first with mineral oil or lidocaine drops before attempting removal using irrigation or instrumental extraction under direct visualization to prevent further injury from the live insect.
Initial Assessment and Preparation
Before attempting removal, assess:
- Whether the bee is alive or dead
- Location of the bee in the ear canal
- Signs of trauma, inflammation, or infection
- Integrity of the tympanic membrane
Step-by-Step Procedure for Bee Removal
1. Kill the Bee First (Critical Step)
- If the bee is alive: Instill several drops of mineral oil, lidocaine, or alcohol into the ear canal 1
- This immobilizes and kills the bee, preventing further movement and potential stinging
- Wait 5-10 minutes after instillation to ensure the bee is dead
2. Removal Techniques (in order of preference)
A. Instrumental Extraction
- Use alligator forceps or Magill forceps under direct visualization with an otoscope or microscope 1
- Grasp the bee firmly but gently and remove in one smooth motion
- This method is preferred for visible, accessible insects that can be directly visualized
B. Irrigation Method
- Use body-temperature water or saline solution to flush out the dead bee 1
- Contraindicated if:
- Tympanic membrane perforation is suspected
- Patient is diabetic or immunocompromised (risk of malignant otitis externa)
- Bee has been in the ear for prolonged period (risk of tissue swelling)
C. Suction Technique
- Use low-pressure suction (100-120 mmHg) to extract the bee 1
- Particularly useful if the bee is fragmented or difficult to grasp
Important Precautions
- Do NOT use cotton swabs - they may push the bee deeper into the canal 1
- Avoid blind finger sweeps - this can cause further injury 1
- Limit removal attempts to prevent trauma or pushing the bee deeper 1
- If the ear canal is edematous: Consider placing a cellulose wick to facilitate removal 1
Post-Removal Care
Examine the ear canal and tympanic membrane for:
- Residual bee parts (particularly the stinger)
- Signs of trauma or perforation
- Evidence of infection or inflammation
If a stinger is present, remove it as quickly as possible regardless of method (scraping or pinching) 2, 3
- Research shows that quick removal is more important than the method used
- Delayed removal increases envenomation and reaction
Consider topical antibiotics if signs of infection are present 1
Monitor for signs of allergic reaction, which may include:
- Local swelling beyond the ear
- Respiratory distress
- Systemic symptoms
When to Refer to a Specialist
- Failed removal attempts
- Deeply impacted bee or fragments
- Significant trauma to the ear canal
- Signs of tympanic membrane perforation
- Development of sudden hearing loss (a rare but reported complication) 4
- Signs of systemic allergic reaction requiring emergency management 5
Follow-up
Schedule follow-up in 1-2 weeks for complicated cases or if there was significant trauma during removal 1.