What is the recommended method for irrigating a child's ear to remove a foreign body?

Ear Irrigation for Foreign Body Removal in Children

For ear foreign body removal in children, gentle irrigation with body-temperature water or saline solution is recommended as an effective method, but should only be performed by healthcare professionals with proper visualization of the ear canal to avoid trauma. 1

Proper Positioning and Technique

• Position the child with the affected ear facing upward to allow the irrigation solution to properly penetrate the ear canal 1, 2
• Maintain this position for 3-5 minutes to ensure the solution can effectively loosen the foreign body 1
• Use gentle to-and-fro movement of the ear or tragal pumping to help the solution penetrate around the foreign object 1
• After appropriate preparation, use body-temperature water or saline solution for the irrigation to avoid causing vertigo or discomfort 3, 1
• Direct the irrigation stream along the wall of the ear canal rather than directly at the tympanic membrane to prevent injury 3

Important Precautions

• Irrigation should not be attempted if there is suspicion of tympanic membrane perforation, presence of ear tubes, or if the child has a history of ear surgery 1, 4
• Avoid irrigation in diabetic or immunocompromised patients as it has been implicated as a contributing factor in malignant otitis externa 1
• Do not attempt ear irrigation at home using oral jet irrigators as these can cause injury to the ear canal 3
• Cotton-tip swabs should never be used for foreign body removal as they can push the object deeper or cause trauma to the ear canal 3, 4
• Ear candles should never be used as they have been shown to cause harm including obstruction of the ear canal with paraffin, hearing loss, and perforation of the tympanic membrane 1

When to Seek Professional Help

• If the child is uncooperative or too young to remain still during the procedure, professional removal under proper visualization is necessary 2, 5
• If there is significant pain, bleeding, or hearing loss, seek immediate professional help 2
• If initial gentle attempts at removal are unsuccessful, do not persist with multiple attempts as this significantly increases complication rates 4
• Consider referral to an otolaryngologist for objects that are deeply embedded, irregular in shape, or when the child cannot cooperate 5, 4

Complications to Be Aware Of

• Multiple attempts at removal, especially by untrained individuals, can lead to canal abrasions, lacerations, bleeding, tympanic membrane perforation, and otitis externa 4
• The complication rate is significantly higher when removal is attempted by non-otolaryngologists (24.4% vs 6.5% when performed by specialists) 4
• Irrigation can cause temporary vertigo, pain, or external auditory canal trauma if performed incorrectly 3

Alternative Methods for Removal

• For certain types of foreign bodies (especially insects), instilling a few drops of mineral oil, olive oil, or alcohol can help immobilize the object before irrigation 2
• Manual removal using appropriate instruments such as forceps or curettes may be necessary if irrigation is unsuccessful, but should only be performed with proper visualization of the ear canal 1, 2
• For high-risk patients, atraumatic cleaning with aural suctioning under microscopic guidance is recommended 1