Ear foreign body

Background

Ear anatomy

• Usually children 6 yo or younger

Foreign Body Types

• Ear foreign body
• Nasal foreign body
• Ocular foreign body
• Aspirated foreign body
• GI
  • Ingested foreign body
    • Bezoar
    • Body packing
    • Esophageal foreign body removal with foley catheter
  • Rectal foreign body
• Soft tissue foreign body

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

• Auricular hematoma
• Auricular perichondritis
• Cholesteatoma
• Contact dermatitis
• Ear foreign body
• Herpes zoster oticus (Ramsay Hunt syndrome)
• Malignant otitis externa
• Otitis externa
• Otomycosis
• Tympanic membrane rupture
  • Otic barotrauma

Internal

• Acute otitis media
  • Bullous myringitis
• Chronic otitis media
• Mastoiditis

Inner/vestibular

• Labyrinthitis, vestibular neuritis
• Meniere's disease
• Sudden sensorineural hearing loss

Evaluation

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

Management

• Button battery - Requires emergent removal (in consultation with ENT)
• Insect - Kill with mineral oil, EtOH, diluted hydrogen peroxide, or 2% lidocaine prior to removal
• Penetrating FB's - Have a low threshold for ENT consult

Removal

• 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
  • 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

• Ofloxacin or ciprofloxacin + dexamethasone if perforated TM or significant trauma to ear canal

Disposition

• Emergent ENT for all button batteries failing ED management
• Urgent ENT consult/follow-up for TM injuries, retained FB, retained insect parts

See Also

• Foreign bodies
• Ear diagnoses

External Links

• ALiEM: PEM Pearls: Search & Rescue of Ear Foreign Bodies – Picking the Right Tool