Creepy crawlies aren't something you would want in your body but they do sometimes find a way in.
That was what a young man found out a few weeks ago, when he sought help at the emergency department of National University Hospital (NUH) for intense pain in his left ear.
"He woke up in the middle of the night with a scurrying sensation in his ear and suspected that an insect had got inside," said Associate Professor Malcolm Mahadevan, a senior consultant and head of the emergency medicine department at NUH.
"True enough, when we looked in his ear with an auroscope, we could see a juvenile cockroach lodged deep in his external auditory canal."
This follows a widely reported incident described in The BMJ medical journal last month, where a "bluish" mass of 17 contact lenses was found in the eye of an elderly woman in Britain who was scheduled for cataract surgery.
Another 10 lenses were found upon further examination.
Doctors do, from time to time, find foreign objects in the body, ranging from coins to toothpicks and creepy crawlies.
Objects can also be swallowed accidentally, inserted forcefully or unknowingly left behind.
Here are some of the items.
An ENT colleague related how he had to take out three cotton buds from a patient's ear at one sitting. The patient wasn't even aware of it until he noticed his hearing had diminished.
DR S.M. TAN, a general practitioner, on cotton swabs being one of the common objects that are left in the ears.
Convenient as they may be, contact lenses also pose hazards. They can, for instance, become lodged in the lower or upper eyelid.
Sometimes, a torn portion of the contact lens may be left behind.
Adjunct Associate Professor Lim Li, a senior consultant at the Singapore National Eye Centre's corneal and external eye disease department, said she has removed a broken lens from the lower eyelid of a patient and retrieved a whole lens from the upper eyelid of another patient.
Referring to the BMJ case, she said: "The case was unusual as the British woman continued to wear her contact lenses even when her vision was blurred. And she must have been quite forgetful if she couldn't remember whether she had removed her lenses or not."
That is why doctors advise patients not to wear contact lenses if their vision is blurred from an eye condition, such as a cataract, Prof Lim added.
If a contact lens is lodged in the lower eyelid, it can be detected and removed by the patient.
However, if it is stuck under the upper eyelid, it may be more difficult to detect and will require an eye examination.
An ophthalmologist will be able to flip up the upper eyelid and remove the lens, she said.
Things that get stuck in the body
Foreign objects can become stuck in various parts of the body, such as the ear and nose. Here are some tips on what you can do to prevent this from happening and how to get rid of them safely.
BUTTON BATTERIES: KEEP THEM AWAY FROM CHILDREN
Always buy toys that have the battery compartment secured with screws to lower the chance of a child obtaining the button battery, said Dr Dennis Chua, a consultant otolaryngologist (ENT) from Mount Elizabeth Hospital.
A button battery stuck in the nose is an emergency that needs immediate attention because it can burn through the nose in 15 minutes, depending on the amount of moisture in the nose and whether it is a fresh battery, he said.
"A button battery generates a localised chemical reaction that results in injuries to the surrounding tissue."
Warning signs include a one-sided runny nose and even nose bleeds, he said.
If you suspect that a button battery is lodged in a child's nose:
•Seek help fast. "It is important to take the patient to a hospital's emergency department the moment a button battery is lodged in the nose," said Dr Chua.
•Do not try to remove the button battery as this can result in injury, he said.
•Do not try flushing it out with water as the moisture can accelerate the chemical reaction generated by the battery, he added.
INSECTS: DROWN THEM IN OIL
Cockroaches or other insects can find their way into your ear in the middle of the night. If the insect's movements cause distress, you can first insert a few drops of olive oil into your ear to drown it, said Dr S.M. Tan, a general practitioner.
Olive oil will not harm you as it is commonly used to soften very hard ear wax to make it easier to flush out.
If you do not have olive oil at home, use any type of clean cooking oil, Dr Tan said. "This is because oil is viscous and will limit the insect's movement, even if it remains alive."
Associate Professor Malcolm Mahadevan, a senior consultant and head of the emergency medicine department at the National University Hospital, said that drowning the insect will stop it from burrowing deeper into the ear and causing more pain.
He also advises those with this issue to consult a doctor to see what is causing the pain, how large the foreign object is and so on.
If the doctor cannot remove it, he will refer the patient to the emergency department at a hospital, he said.
COTTON SWABS: DO NOT USE THEM TO CLEAN YOUR EARS
The American Academy of Otolaryngology- Head and Neck Surgery has advised: "Don't put anything smaller than your elbow in your ear."
Small items like cotton swabs, hair pins, car keys and toothpicks can injure your ear and may cause a cut in your ear canal, poke a hole in your ear drum or hurt the hearing bones, leading to hearing loss, dizziness, ringing and other symptoms, it said on its website.
The ears are self-cleaning and ear wax is meant to protect your ear canal skin and kill germs.
Prof Mahadevan said cockroaches in the ear are quite common. "It can be painful after the nymph or juvenile cockroach burrows itself deep in the ear canal next to the ear drum."
What doctors do is to drown the insect with some olive oil before removing it with a pair of forceps.
Apart from cockroaches, insects such as ants, moths and beetles can also find their way into a person's ear.
COINS, BATTERIES AND OTHER SMALL THINGS
Children can accidentally swallow or stuff small objects like coins, beads or bits of erasers into their nose or ears.
Dr S.M. Tan, a general practitioner, said she once attended to a child with a magnet inside his ear.
"As I was using a forcep to try to retrieve it, the magnet "jumped" out, attracted to the metal of the forcep."
In another case that she saw many years ago when she was working in a polyclinic, a three-year-old had swallowed a five-cent coin and a 10-cent coin.
The coins showed up in the abdominal X-ray and were later passed out naturally, so the child was not adversely affected.
But not all small items can be passed out easily. Button batteries, in particular, must not be inserted into the body.
"I often tell parents to keep small batteries, such as the disc-shaped ones used in wristwatches, away from children, said Dr Tan.
" If they get lodged in a child's ear or nose, the acid that leaks from the battery can lead to catastrophic damage of the tissue."
In Singapore, the cotton-tipped swab is one of the common objects that get left in the ear, said Prof Mahadevan.
Agreeing, Dr Tan said: "I see such cases and ENT (ear, nose and throat) surgeons see it all the time."
This is because people like to clean their ears with Q-tips, she said.
"An ENT colleague related how he had to take out three cotton buds from a patient's ear at one sitting," said Dr Tan. "The patient wasn't even aware of it until he noticed his hearing had diminished."
Sticking cotton swabs in your ears can result in ear wax being "impacted", said Dr Tan. This means the wax is pushed back into the ear, blocking the ear canal, which can cause pain, muffled hearing, tinnitus (ringing in the ears) and a feeling of imbalance.
Sometimes, doctors find the most surprising things in the body which may have to be removed surgically.
These items can be unintentionally left behind by people seeking sexual gratification, for instance, or during an operation.
A doctor in private practice said soap, soap cases and even shampoo bottles and bananas have been found in the rectum of patients.
Dr Tan said that many years ago, she heard about a man who went to an emergency department here to get a vibrator which went too far up his anus to be removed.
"The sound of the vibrator, which was still turned on, could be heard through his abdomen."
Dr Yang Ching Yu, a general and colorectal surgeon and consultant at Raffles Surgery Centre, said he had extracted an unlikely object from a foreign patient who saw him for severe abdominal pain about four months ago.
The woman had been having frequent abdominal pain after undergoing a caesarean operation five months ago, before she relocated to Singapore.
"When I cut open her abdomen, there was a pungent, rotten smell that was released from the abdominal cavity," said Dr Yang.
And in the intra-abdominal abscess was a 20cm x 20cm soiled towel, which was stuck to the obstructed segment of the small bowel, he said.
"The towel did not have the usual radio-opaque thread found in the pad or towels used in surgery. Otherwise, it would have been detected in the pre-operative CT (computed tomography) scan."
The towel was probably left behind in the abdomen during the caesarean section procedure that was performed in another country.
Fortunately, after the obstructed segment of the intestine was resected and the abdomen cavity cleaned thoroughly, the woman recovered without complications.
Her abdominal pain also disappeared, said Dr Yang.