If the patient is difficult to restrain or is in severe pain, then conscious sedation or anesthesia may be required.
Materials that can immobilize or kill the insect:
(1) topical lidocaine or other local anesthetic (may help to reduce patient discomfort)
(2) microscope immersion oil (help reduce friction for easier removal)
(3) mineral oil
If the tympanic membrane is intact:
(1) immersion or mineral oil can be used to immobilize the insect
(2) lavage can be used to eject the insect
If the tympanic membrane is not intact:
(1) topical lidocaine can be used to immobilize the insect
(2) lavage should not be used to remove the insect
(3) instrumentation should be used with care, especially if the insect is wedged in
Once the insect is removed, it should be carefully examined microscopically for missing mouth parts or barbed appendages. This should include examining the insect for symmetry. An embedded insect part can become infected and cause an external otitis.
An operating microscope can greatly assist insect removal, especially if there are retained parts.
