A 19-year-old woman presents to the Emergency Department after an insect flew into her ear. She is complaining of significant pain and can hear the insect buzzing. The triage nurse has administered pain relief, and the patient is now comfortable.

1. What should be your first step in the management of this patient?

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Insect removal from the ear can be challenging due to the distress that it causes the patient and the inevitable movement of the insect during the process.

The patient should be made comfortable initially with analgesia. Inhaled Entonox can be helpful, and, on occasion, sedation will be necessary if the patient is very distressed or in great discomfort.

2. What should you do next?

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The first step in the process of removal should be killing or immobilising the insect to prevent movement during removal and ongoing intra-aural damage by the insect. Options for this include microscope immersion oil, mineral oil and lidocaine solution.

3. How can the insect be removed after this?

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The subsequent removal can be performed using forceps, but the Frazier suction technique is also very effective. The Frazier suction device can usually be located in in most ENT kits.

After you have inspected the ear and conformed that the insect is dead connect the Frazier suction device to low continuous suction and slowly advance it into the patient’s external ear canal. Occlude the insufflation port to suction out the contents of the patient’s ear canal. Once no more liquid returns, withdraw the catheter and check that the insect has been successfully removed.


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