A client arrives at the emergency room with a foreign body in the left ear that has been determined to be an insect. Which intervention would the nurse anticipate to be prescribed initially?
A. Irrigation of the ear.
B. Instillation of diluted alcohol.
C. Instillation of antibiotic ear drops.
D. Instillation of corticosteroids ear drops.
Correct Answer: B. Instillation of diluted alcohol.
Insects are killed before removal unless they can be coaxed out by a flashlight or a humming noise. Mineral oil or diluted alcohol is instilled into the ear to suffocate the insect, which then is removed by using forceps. For patients with significant discomfort (typically from a live insect), apply a topical anesthetic or give local anesthesia as a regional auricular block.
Option A: When the foreign object is vegetable matter, irrigation is not used because this material expands with hydration and the impaction becomes worse. Irrigation should not be attempted if the object is soft or a seed or other vegetable matter that may swell when water is added.
Option C: If there is any injury to the canal or tympanic membrane, have the patient keep the ear dry until they are reassessed (ear precautions are needed for 1 week in the case of a perforated tympanic membrane); consider prescribing ciprofloxacin/corticosteroid suspension drops for 3 to 5 days.
Option D: After the foreign body is removed, inspect the external canal. For most foreign bodies, no medications are needed. However, if infection or abrasion is evident, fill the ear canal 5 times/day for 5-7 days with a combination antibiotic and steroid otic suspension.
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