The methods employed for the removal of a foreign body are syringing,
extraction by instruments through the external meatus, and removal by
operation by making a post-auricular incision and reflecting forward the
auricle.
=By syringing.= In the vast majority of cases syringing is successful,
and therefore should always be tried except under the following
conditions:--(_a_) If the foreign body be of such a nature that it may
be driven inwards; for example, a percussion cap for a toy pistol, lying
with its concavity outwards.
(_b_) If there be much inflammation and swelling of the walls of the
external meatus, unfortunately frequently due to previous unsuccessful
attempts at extraction by instruments. In such cases forcible syringing
may cause considerable pain, and in addition immediate removal of the
foreign body may be impossible owing to the temporary occlusion of the
meatus.
Unless urgent symptoms of retention of pus behind the foreign body are
present, it is wiser to wait for a few days until the inflammation has
subsided, in order that the canal may become more patent and permit of a
more favourable opportunity for removal of the foreign body. The
auditory canal, in the meanwhile, may be mopped out two or three times a
day with pledgets of cotton-wool, and a 1 in 5,000 alcoholic solution of
biniodide of mercury afterwards instilled into the ear.
The method of syringing has already been described (see p. 308). The
syringe should be a large one with its tip protected by some
india-rubber tubing. The point is inserted within the meatus up against
the foreign body and the stream of lotion is directed towards any chink
which may exist between it and the auditory canal. It may be necessary
to use many syringefuls with considerable force before the foreign body
can be expelled, but the syringing should be stopped if pain or
giddiness are caused.
If the foreign body cannot be removed at the first attempt, drops of
rectified spirit may be instilled into the ear several times a day,
provided there are no urgent symptoms. This will tend to diminish any
swelling of the soft tissues of the external meatus and of the foreign
body if it is a vegetable substance. The ear should again be syringed
after two or three days. In many cases this will now be successful; if
not, the foreign body may be moved gently with a probe (using a speculum
and reflected light), great care being taken not to push it further into
the auditory canal, and another attempt may be made to remove it by
prolonged syringing. If this fails it may be left _in situ_ for a still
longer period, provided there are still no symptoms requiring its
immediate removal. In some cases, instead of the instillation of
alcohol, a 5% solution of carbolic acid in glycerine or olive oil proves
more effectual.
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