A 4-year-old female has a peanut lodged in the external auditory canal of her right ear. What is the best course of action?

• A. Thoroughly flush her ear with sterile saline
• B. Transport her to the Emergency Department
• C. Use tweezers to try to remove the object
• D. Remove the peanut with a cotton-tipped swab

Answer: (B)

The situation centers on safely removing a foreign body from a child’s external ear without causing further injury. A peanut lodged in the ear canal is an organic object that can swell when moistened and is more likely to worsen if manipulated improperly. Because field removal with instruments like tweezers or cotton-tipped swabs risks pushing the object deeper, causing trauma to the ear canal, or leaving behind fragments, the best course is to transport the child to the emergency department where trained clinicians can visualize the canal with an otoscope and remove the object with appropriate tools, and assess for complications such as tympanic membrane injury or infection. In the ED, removal can be done safely, using suction or specialized atraumatic forceps, and under proper assessment of the ear.