Ear foreign body

Background
Ear anatomy
  • Usually children 6 yo or younger

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
  • 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

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


References
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