{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T01:37:24Z","timestamp":1790127444181,"version":"4.0.1"},"reference-count":25,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:p> A live insect within the external auditory canal is an unpleasant possibility during wilderness recreation. To our knowledge, no study has attempted to quantify the risk of this event occurring in the wilderness. However, such events anecdotally seem to occur with some regularity in a variety of climates. Most cases are benign, but a small subset of patients can develop complications including infection, hearing loss, and vestibular complaints related to the foreign body. In the emergency department or clinic, removal of the insect is a simple procedure in most circumstances; however, the material and expertise required for backcountry removal of the insect are often limited. With this consideration in mind, we offer a conservative approach to backcountry insect removal based on a selective review of the published literature on this topic. Where published data are lacking, we make recommendations based on anecdotal experience of the authors dealing with this condition in austere environments and in the emergency department. We recommend insect removal only if the patient is acutely symptomatic and the insect is visualized and graspable with the instrument used for removal. In any other circumstance, intervention should be deferred until definitive care is reached because of risks of complications associated with removal, including infection, bleeding, and tympanic membrane damage. <\/jats:p>","DOI":"10.1016\/j.wem.2022.03.013","type":"journal-article","created":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T03:03:04Z","timestamp":1653620584000},"page":"318-323","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Management of Live Insects in the External Auditory Canal: A Wilderness Perspective"],"prefix":"10.1177","volume":"33","author":[{"given":"Andrew","family":"Giltmier","sequence":"first","affiliation":[{"name":"University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Aunins","sequence":"additional","affiliation":[{"name":"University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey L.","family":"Ishman","sequence":"additional","affiliation":[{"name":"University of Cincinnati College of Medicine, Cincinnati, Ohio"},{"name":"Division of Pediatric Otolaryngology\u2013Head and Neck Surgery, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conal","family":"Roche","sequence":"additional","affiliation":[{"name":"University of Cincinnati College of Medicine, Cincinnati, Ohio"},{"name":"Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,9,1]]},"reference":[{"key":"bibr1-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1093\/jee\/51.4.546a"},{"key":"bibr2-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200101000-00003"},{"key":"bibr3-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1080\/00034983.1999.11813406"},{"issue":"1","key":"bibr4-j.wem.2022.03.013","first-page":"45","volume":"14","author":"Fornazieri M.A.","year":"2010","journal-title":"Int Arch Otorhinolaryngol"},{"key":"bibr5-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1016\/S0733-8627(20)31086-5"},{"key":"bibr6-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200311000-00010"},{"key":"bibr7-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1177\/0145561319893164"},{"key":"bibr8-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1097\/01.pec.0000227866.46439.3f"},{"key":"bibr9-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1002\/lary.5541030401"},{"key":"bibr10-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215115000961"},{"key":"bibr11-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2020-236723"},{"key":"bibr12-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2019.01.010"},{"key":"bibr13-j.wem.2022.03.013","first-page":"272","volume-title":"Advanced Wilderness Life Support: Prevention, Diagnosis, Treatment, Evacuation","author":"Ingebretsen R.","year":"2016","edition":"9"},{"key":"bibr14-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(05)80402-0"},{"issue":"6","key":"bibr15-j.wem.2022.03.013","first-page":"437","volume":"40","author":"Lai P.","year":"2011","journal-title":"J\u00a0Otolaryngol Head Neck Surg"},{"key":"bibr16-j.wem.2022.03.013","first-page":"114","volume-title":"Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care","author":"Forgey W.W.","year":"2006","edition":"5"},{"key":"bibr17-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1580\/1080-6032(2000)011[0138:LTTE]2.3.CO;2"},{"key":"bibr18-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1973.00780020046011"},{"key":"bibr19-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1177\/000348946207100111"},{"key":"bibr20-j.wem.2022.03.013","volume-title":"StatPearls [Internet]","author":"Dolhi N.","year":"2021"},{"key":"bibr21-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1016\/j.wem.2014.04.005"},{"key":"bibr22-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1016\/j.emc.2018.09.009"},{"key":"bibr23-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.2147\/OAEM.S178850"},{"key":"bibr24-j.wem.2022.03.013","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200207000-00005"},{"issue":"1","key":"bibr25-j.wem.2022.03.013","first-page":"64","volume":"9","author":"Bhandary S.","year":"2002","journal-title":"Pac Health Dialog"}],"container-title":["Wilderness &amp; 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