Concepts| Volume 33, ISSUE 3, P318-323, September 2022

Management of Live Insects in the External Auditory Canal: A Wilderness Perspective

      A live insect within the external auditory canal is an unpleasant possibility during wilderness recreation. To our knowledge, no study has attempted to quantify the risk of this event occurring in the wilderness. However, such events anecdotally seem to occur with some regularity in a variety of climates. Most cases are benign, but a small subset of patients can develop complications including infection, hearing loss, and vestibular complaints related to the foreign body. In the emergency department or clinic, removal of the insect is a simple procedure in most circumstances; however, the material and expertise required for backcountry removal of the insect are often limited. With this consideration in mind, we offer a conservative approach to backcountry insect removal based on a selective review of the published literature on this topic. Where published data are lacking, we make recommendations based on anecdotal experience of the authors dealing with this condition in austere environments and in the emergency department. We recommend insect removal only if the patient is acutely symptomatic and the insect is visualized and graspable with the instrument used for removal. In any other circumstance, intervention should be deferred until definitive care is reached because of risks of complications associated with removal, including infection, bleeding, and tympanic membrane damage.


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        • Maddock D.E.
        • Fehn C.F.
        Human ear invasions by adult scarabaeid beetles.
        J Econ Entomol. 1958; 51: 546-547
        • Antonelli P.J.
        • Ahmadi A.
        • Prevatt A.
        Insecticidal activity of common reagents for insect foreign bodies of the ear.
        Laryngoscope. 2001; 111: 15-20
        • Indudharan R.
        • Ahamad M.
        • Ho T.M.
        • Salim R.
        • Htun Y.N.
        Human otoacariasis.
        Ann Trop Med Parasitol. 1999; 93: 163-167
        • Fornazieri M.A.
        • Cutolo D.
        • Moreira J.H.
        • de Lima Navarro P.
        • Takemoto L.E.
        • Heshiki R.E.
        • et al.
        Foreign-body in external auditory meatus: evaluation of 462 cases.
        Int Arch Otorhinolaryngol. 2010; 14: 45-49
        • Fritz S.
        • Kelen G.D.
        • Sivertson K.T.
        Foreign bodies of the external auditory canal.
        Emerg Med Clin North Am. 1987; 5: 183-192
        • Thompson S.K.
        • Wein R.O.
        • Dutcher P.O.
        External auditory canal foreign body removal: management practices and outcomes.
        Laryngoscope. 2003; 113: 1912-1915
        • Kim K.H.
        • Chung J.H.
        • Byun H.
        • Zheng T.
        • Jeong J.H.
        • Lee S.H.
        Clinical characteristics of external auditory canal foreign bodies in children and adolescents.
        Ear Nose Throat J. 2020; 99: 648-653
        • Marin J.R.
        • Trainor J.L.
        Foreign body removal from the external auditory canal in a pediatric emergency department.
        Pediatr Emerg Care. 2006; 22: 630-634
        • Bressler K.
        • Shelton C.
        Ear foreign-body removal: a review of 98 consecutive cases.
        Laryngoscope. 1993; 103: 367-370
        • Sikka K.
        • Agrawal R.
        • Devraja K.
        • Lodha J.V.
        • Thakar A.
        Hazardous complications of animate foreign bodies in otology practice.
        J Laryngol Otol. 2015; 129: 540-543
        • Alex A.
        • Philip A.
        • Paulose A.A.
        • Mammen M.D.
        • Lepcha A.
        Skull base osteomyelitis with secondary cavernous sinus thrombosis: a rare presentation of an animate foreign body in the ear.
        BMJ Case Rep. 2021; 14e236723
        • Mingo K.
        • Eleff D.
        • Anne S.
        • Osborne K.
        Pediatric ear foreign body retrieval: a comparison across specialties.
        Am J Otolaryngol. 2020; 41: 102167
      1. Wilderness medical kits.
        in: Ingebretsen R. Della-Giustina D. Advanced Wilderness Life Support: Prevention, Diagnosis, Treatment, Evacuation. 9th ed. AdventureMed, Salt Lake City, UT2016: 272-290
        • Leffler S.
        • Cheney P.
        • Tandberg D.
        Chemical immobilization and killing of intra-aural roaches: an in vitro comparative study.
        Ann Emerg Med. 1993; 22: 1795-1798
        • Lai P.
        • Coulson C.
        • Pothier D.
        • Rutka J.
        Chlorhexidine ototoxicity in ear surgery, part 1: review of the literature.
        J Otolaryngol Head Neck Surg. 2011; 40: 437-440
        • Forgey W.W.
        Wilderness medical kits.
        in: Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care. 5th ed. The Globe Pequot Press, Guilford, CT2006: 114-117
        • Kizer K.W.
        Intra-aural insects, lidocaine, and vertigo.
        Wilderness Environ Med. 2000; 11: 138-139
        • Simmons F.B.
        • Glattke T.J.
        • Downie D.B.
        Lidocaine in the middle ear: a unique cause of vertigo.
        Arch Otolaryngol. 1973; 98: 42-43
        • Rahm W.E.
        • Strother W.F.
        • Crump J.F.
        • Parker D.E.
        The effects of anesthetics upon the ear. IV. Lidocaine hydrochloride.
        Ann Otol Rhinol Laryngol. 1962; 71: 116-123
        • Dolhi N.
        • Weimer A.D.
        Tympanic membrane perforations. [Updated 2021 Aug 11].
        in: StatPearls [Internet]. StatPearls Publishing, Treasure Island, FL2021
        • Quinn R.H.
        • Wedmore I.
        • Johnson E.
        • Islas A.
        • Anglim A.
        • Zafren K.
        • et al.
        Wilderness medical society practice guidelines for basic wound management in the austere environment.
        Wilderness Environ Med. 2014; 25: 295-310
        • Oyama L.C.
        Foreign bodies of the ear, nose and throat.
        Emerg Med Clin North Am. 2019; 37: 121-130
        • Ng T.T.
        Aural foreign body removal: there is no one-size-fits-all method.
        Open Access Emerg Med. 2018; 10: 177-182
        • Roland P.S.
        • Stroman D.W.
        Microbiology of acute otitis externa.
        Laryngoscope. 2002; 112: 1166-1177
        • Bhandary S.
        • Karki P.
        • Sinha B.K.
        Malignant otitis externa: a review.
        Pac Health Dialog. 2002; 9: 64-67