Ear foreign body
Background
- Usually children 6 yo or younger
Foreign Body Types
- Ear foreign body
- Nasal foreign body
- Ocular foreign body
- Aspirated foreign body
- GI
- 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
Internal
- Acute otitis media
- Chronic otitis media
- Mastoiditis
Inner/vestibular
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[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
- 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
External Links
References
- ↑ 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