Ear emergencies

Definition

Ear emergencies include objects stuck in the ear and ruptured eardrums.

See also: Acoustic trauma

Considerations

Children often stick objects into their ears. These objects can be difficult to remove because the ear canal is a tube of solid bone that is lined with thin, sensitive skin. Any object pressing against the skin can be very painful. In many cases, a doctor will need to use special instruments to examine the ear and safely remove the object.

Causes

Pain, hearing loss, dizziness, ringing in the ear, and ruptured eardrums can be caused by:

• Inserting cotton swabs, toothpicks, pins, pens, or other objects into the ear.
• Sudden changes in pressure, as from an explosion, blow to the head, flying, scuba diving, falling while water skiing, or being slapped on the head or ear.
• Loud percussions, such as a gun going off.

Symptoms

• Dizziness
• Loss of hearing
• Nausea and vomiting
• Noises in the ear
• Earache
• Bleeding from the ear
• Bruising or redness
• Swelling
• Object visible in the ear
• Sensations of an object in the ear
• Clear liquid coming out of the ear (brain fluid)

First Aid

Follow the steps below, depending on the type of ear emergency.

OBJECT IN THE EAR

1. Calm and reassure the person.
2. If the object is sticking out and easy to remove, gently remove it by hand or with tweezers. Then, get medical help to make sure the entire object was removed.
3. If you think a small object may be lodged within the ear, but you cannot see it, DO NOT reach inside the ear canal with tweezers. You can do more harm than good.
4. Try using gravity to get the object out by tilting the head to the affected side. DO NOT strike the person's head. Shake it gently in the direction of the ground to try to dislodge the object.
5. If the object doesn't come out, get medical help.

INSECT IN THE EAR

1. DO NOT let the person put a finger in the ear, since this may make the insect sting.
2. Turn the person's head so that the affected side is up, and wait to see if the insect flies or crawls out.
3. If this doesn't work, try pouring mineral oil, olive oil, or baby oil into the ear. As you pour the oil, pull the ear lobe gently backward and upward for an adult, or backward and downward for a child. The insect should suffocate and may float out in the oil. AVOID using oil to remove any object other than an insect, since oil can cause other kinds of objects to swell.

RUPTURED EARDRUM

1. The person will have severe pain. Place sterile cotton gently in the outer ear canal to keep the inside of the ear clean.
2. Get medical help.

CUTS ON THE OUTER EAR

1. Apply direct pressure until the bleeding stops.
2. Cover the injury with a sterile dressing shaped to the contour of the ear, and tape it loosely in place.
3. Apply cold compresses over the dressing to reduce pain and swelling.
4. If part of the ear has been cut off, keep the part. Get medical help immediately.

DRAINAGE FROM INSIDE THE EAR

1. Cover the outside of the ear with a sterile dressing shaped to the contour of the ear, and tape it loosely in place.
2. Have the person lie down on the side with the affected ear down so that it can drain. However, DO NOT move the person if a neck or back injury is suspected.
3. Get medical help immediately.

DO NOT

• DO NOT block any drainage coming from the ear.
• DO NOT try to clean or wash the inside of the ear.
• DO NOT attempt to remove the object by probing with a cotton swab, pin, or any other tool. To do so will risk pushing the object farther into the ear and damaging the middle ear.
• DO NOT reach inside the ear canal with tweezers.

When to Contact a Medical Professional

The following symptoms, which may indicate significant trauma to the ear, should be evaluated by a physician:

• Pain in the ear
• Ringing sounds
• Dizziness (vertigo) 
• Hearing loss
• Drainage or blood from the ear
• Recent blow to your ear or head

Prevention

• Never put anything in the ear canal without first consulting a physician.
• Never thump the head to try to correct an ear problem.
• Teach children not to put things in their ears.
• Avoid cleaning the ear canals altogether.
• Following an ear injury, avoid nose blowing and getting water in the injured ear.
• Treat ear infections promptly.

If you tend to feel pain and pressure when flying, drink lots of fluid before and during the flight. Avoid the use of alcohol, caffeine, or tobacco on the day of the flight. Chew gum, suck on a hard candy, or yawn during take off and landing. Talk to your doctor about taking a decongestant or using a nasal spray before you fly.

Auerbach PS. Wilderness Medicine. 4th ed. St. Louis, Mo: Mosby; 2001:468-470.

DeLee JC, Drez, Jr., D, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 2nd ed. Philadelphia, Pa: Saunders; 2003:758.

DiMuzio J Jr, Deschler DG. Emergency department management of foreign bodies of the external ear canal in children. Otol Neurotol. 2002 Jul;23(4):473-5.