Ear foreign body

Background

Ear anatomy
  • Usually children 6 years old or younger

Foreign Body Types

Clinical Features

  • Caregiver often reports seeing child put something in the ear
  • Decreased hearing or otalgia
  • More common on right (hand dominant) side
  • May have otorrhea or bleeding
  • Foreign body contacting tympanic membrane can cause intractable hiccups

Differential Diagnosis

Ear Diagnoses

External

Internal

Inner/vestibular

Evaluation

  • Typically seen on visual inspection or otoscopy
  • Check other ear / nares

Management

Schema showing typical foreign body location in relation to ear canal.

General Removal Options

  • Irrigation
    • Contraindicated if suspected TM perforation, tympanostomy tubes, button battery, or vegetable parts (swells)
    • Body temperature sterile water or normal saline to avoid inducing nystagmus
    • Attach 14 or 16 ga IV catheter to 20-60 mL syringe
    • Can also utilize an infant nasogastric tube instead of an IV catheter, place tip of catheter next to TM, connect syringe and irrigate
  • Alligator forceps
  • Right angle tool / day hook
  • Scoop with curette (lighted curette helpful)
  • Schuknecht extractor (attaches to wall suction)
  • Dermabond on a swab stick[1]
    • Allow glue to become tacky before inserting into canal
    • May use disposable ear speculum to shield canal so do not accidentally glue stick to ear canal

Antibiotics

Insects

  • May wish to first kill (e.g., with mineral oil, EtOH, diluted hydrogen peroxide, or 2% lidocaine) prior to removal
  • In an in-vitro trial mineral oil was faster and more effective than other methods to kill cockroaches[2]
  • Sometimes use of killing agents may make insects soft and mushy, thus making it more difficult to remove all pieces. In this case, may consider irrigation afterwards, to remove all parts. Or, may alternatively defer injection of liquid and prefer swift removal, if a viable option (e.g., with a compliant, non-pediatric patient)

Button Batteries

  • Requires emergent removal (consider ENT consult)

Disposition

  • Most patients with foreign body removal and no significant complications can be discharged
  • Consider urgent ENT consult/follow-up for TM injuries, retained FB, retained insect parts
  • Emergent ENT for all button batteries failing ED management

Complications

See Also

External Links

References

  1. ↑ Pride H, Schwab R. A new technique for removing foreign bodies of the external auditory canal. Pediatr Emerg Care. 1989;5(2):135-136. doi:10.1097/00006565-198906000-00017
  2. ↑ Leffler, S., Cheney, P., & Tandberg, D. (1993). Chemical immobilization and killing of intra-aural roaches: an in vitro comparative study. Annals of emergency medicine, 22(12), 1795–1798. https://doi.org/10.1016/s0196-0644(05)80402-0
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