# 275 Horrendous in the Grass
It's one of those nights when the department is packed overcrowded and patient flow is obstipated. You're at Triage, trying to hasten assessments and begin initial measures without being tied up with direct patient care: yeah, right!
A very uncomfortable 35-year-old man complains of left ear pain since romping with his dog and rolling in dried grass. The "foxtail" that he thinks he has in his ear can be readily seen. He agrees to letting you remove it.
You fetch a wide metal ear speculum, Hartman's (Alligator) Forceps, and some 10% topical lidocaine spray. Warning him of the sensation of warmth, you gently spritz the anesthetic into the canal (tympanic membrane is intact). In seconds, he is delighted to be free of pain. There's no ENT chair, so he agrees to steady his head with his hand and that elbow with the other hand. Although the widest parts of the foxtail face you and are likely to dig in, you're able to carefully remove the foxtail and verify no scratches to the irritation.
You give him some cautions: don't dig at it with his finger; return if worse, any change in hearing, or ear discharge; don't immerse ear until well; avoid foxtails in future. You sign him out with essential documentation. Having spared the treatment area from a "minor" patient and long wait, you feel internal satisfaction and move onto the next arriving patient.
Dance, D., & Ludemann, J. P. (2009). Removal of ear canal foreign bodies in children: What can go wrong and when to refer. BCMJ, 51(1), 20-24. [PDF]
Davies, P. H., & Benger, J. R. (2000). Foreign bodies in the nose and ear: a review of techniques for removal in the emergency department. Emergency Medicine Journal, 17(2), 91-94. [PDF]
Michelle Lin, MD. Trick of the Trade: A mini-suction device. ALiEM: Academic Life in Emergency Medicine. June 29th, 2011.
Mitchell Li, MD. Trick of the Trade: Insect removal from the ear. ALiEM: Academic Life in Emergency Medicine. October 2nd, 2014.
Adedeji, T. O., Sogebi, O. A., & Bande, S. (2016). Clinical spectrum of ear, nose and throat foreign bodies in North Western Nigeria. African health sciences, 16(1), 292-297. [PDF]
doi: 10.4314/ahs.v16i1.38 PMID: 27358644 PMCID: PMC4915433
Robin Mantooth, MD, FACEP. Ear Foreign Body Removal in Emergency Medicine. emedicinemedscape.com. Updated: May 16th, 2017.
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