Removing earrings embedded in the ear lobe

On occasion you will encounter a patient with an earring stuck in their ear lobe. This most commonly occurs in girls younger than 12-13 years of age and is related to a combination of factors.

Younger children tend be less likely to perform adequate hygiene, and they are more likely to irritate the area by playing with their earrings
Local contact dermatitis caused by earrings, poor hygiene and pressure on the pinna caused by wearing earrings can all lead to skin ischemia, inflammation and ulcer formation with associated swelling and increased risk of earrings becoming imbedded in the pinna

Patients with embedded earrings often present with ear pain, swelling, erythema and purulent drainage from the site of the piercing. The area is usually quite tender to the touch. Typically at least part of the earring is visible or palpable, however plain radiographs may be needed to confirm the diagnosis.

Suspected embedded earrings should be removed as soon as possible to avoid infection.

It is important to obtain adequate analgesia with either local infiltration or field block prior to removal. Procedural sedation may be required in younger patients.

The area should be prepared/cleaned using sterile technique in case an incision is required for removal

Mosquito hemostats can be used to grasp both the anterior (the decorative front) and posterior (the backing or clip that holds the earring in place) parts of the earring. Use the hemostats to disengage the backing from the post and then pull the earring out of the pinna.

If the front is visible, apply pressure to the front until the posterior backing or clip become visible. Clamp a hemostat to the backing and disengage it from the earring by pulling the backing while holding the earring in place anteriorly. It may be necessary to create a small incision on the posterior portion of the pinna and spread the skin using a hemostat to get the clip in view.

If the backing or clip is visible with the anterior earring embedded, push the earring anteriorly until the decorative front is visible. Clamp a hemostat to the front once visible then disengage the clip/backing and pull the earring out. Again, it may be necessary to create an incision to increase visibility, but incision should be made on the posterior portion of the pinna.

If nothing is visible, start with an incision on the posterior portion of the pinna and spread the skin with a hemostat until the backing or clip becomes visible. Grasp the backing with a hemostat and apply posterior pressure until the anterior decorative portion becomes visible and a hemostat can be used to disengage the two pieces of the earring.

Once the earring is removed, the area should be dressed with antibiotic ointment and left to heal by secondary intention. For the most part, oral antibiotics are not needed after removal of an embedded earring from the ear lobe.

However, piercings in the cartilaginous portions of the ear have been associated with perichondritis, chondritis and occasionally permanent disfigurement. Embedded earrings in the cartilaginous portions of the ear present similarly to those embedded within the ear lobe, with swelling, erythema and tenderness. Given the risks of cartilage necrosis and cosmetic disfigurement associated with cartilage piercings, it is best to involve an otolaryngologist in the management. In these cases, oral antibiotics are often necessary to treat both pseudomonal infections (involved in up to 95% of cases) and staphylococcal infections.

A retrospective chart review published in 2008 by Timm and Iyer examined incidence, age distribution and management of children with embedded earrings presenting to the CCHMC ED between June 2000 and January 2005. It ultimately included 100 patients over the study period. This study found that incidence of embedded earring as a chief complaint was 25 cases per 100,000 visits. Of the 100 patients included in this study, 60% were younger than 10 years of age. In 68% of the cases, the posterior portion of the earring was embedded. In 35% of the cases, there was an associated infection (which was less than reported in previous studies with infections in about 61-65% of patients with embedded earrings). However, 73% of children with piercings outside of the ear lobe or tragus had associated infections, some of which required IV antibiotics. None of the cases required procedural sedation for removal, but 47% of them required the use of an incision to aid in removal (Timm, Iyer 2008).