Introduction: Foreign bodies in the external auditory canal are an uncommon presentation in emergency settings. Among adults, insects represent a frequent organic foreign body, often causing symptoms such as otalgia, tinnitus, vertigo, and anxiety. Prehospital management of such cases is rarely addressed in the medical literature, with minimal guidance available for emergency medical services (EMS) personnel. In this report we discuss their role in stabilizing patients and reducing discomfort through appropriate interventions.
Case Report: A 40-year-old male called EMS after a live insect entered his left ear, causing severe otalgia and distress. Prehospital medical personnel clinically confirmed the presence of the insect and assessed for signs of tympanic membrane perforation. A medical command physician authorized the use of 2% lidocaine to euthanize the insect, which alleviated movement-related discomfort within 20 seconds. Despite initial symptom relief, the patient experienced persistent fullness in the ear and was transported to a tertiary-care hospital. In the emergency department multiple removal attempts were made, with successful extraction using thin dressing forceps. No tympanic membrane perforation was noted, although minor trauma to the external auditory canal was present. The patient was discharged with ciprofloxacin-dexamethasone otic drops and return precautions.
Conclusion: Prehospital use of lidocaine for a live insect in the auditory canal may provide significant symptom relief while reducing the risk of further auditory canal trauma. This case underscores the importance of command-based support for EMS personnel to provide safe, evidence-based approaches for managing intra-aural insects in the field
