Foreign body in the ear

Notes

## Basic introduction

  • Foreign bodies (FBs) are more common in younger children due to curiosity to explore orifices, imitation, boredom, playing, mental retardation, insanity, and attention deficit hyperactivity disorder, among others
  • Generally, most FBs can be removed without complications
  • Some of the FBs include: insects, erasers, toys, cotton wool (from ear bud), beans, and beads

## Statistics

  • 3% of all cases that were seen at ENT Emergency unit of Federal University of São Paulo, Paulista School of Medicine (UNIFESP-EPM) Brazil between February of 2010 and January of 201 were due to FBs, 64.4% of which affected the ear
  • Globally, FBs have been estimated to account for approximately 11% of the cases seen in ENT services
  • Severe complications are known to occur in about 22% of the cases of FBs of ENT
Symptoms
  • Feeling of the presence of FB in the ear (not always)
  • Disturbing noise of insect
  • Pain
  • Discharge (otorrhea)
  • Decreased hearing (otalgia) or deafness
  • Foul smelling discharge, swollen ear canal, and erythema (in case of delayed medical care)
  • Intractable hiccups (sometimes)

## Complications of FBs in the ear

  • Infections
  • Abrasion
  • Bleeding
  • Perforation of tympanic membrane
  • Formation of granuloma
Diagnosis
  • Clinical review
  • FBs are normally seen on visual inspection or otoscopy
Differential
  • Auricular hematoma
  • Contact dermatitis
  • Otitis externa
  • Acute otitis media
  • Tympanic membrane rupture
Prevention
  • Proper child training and care by parents/caretakers
Reference

a. Heim SW, Maughan KL; Foreign bodies in the ear, nose, and throat. Am Fam Physician. 2007 Oct 15 76(8):1185-9.Ong ME, Ooi SB, Manning PG

b. Shrestha, I., Shrestha, B. L., & Amatya, R. C. M. (2013). Analysis of ear, nose and throat foreign bodies in Dhulikhel hospital. Kathmandu University Medical Journal, 10(2), 4-8.

c. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf

Management
  • Most of the FBs do not require immediate removal but batteries should be removed as an emergency as they are corrosive and they can cause permanent damage to the tympanic membrane
  • Care must be exercised when removing the FBs as a number of such efforts normally end up pushing the object further in the ear or injuring the ear canal
  • Where the FB is an insect, apply either 2% lidocaine or mineral oil or alcohol into the ear to first kill it before removal
  • Acetone has been used to remove superglue, chewing gum and Styrofoam from the ear
  • A repeat examination of the ear after the removal of FBs is recommended.

## Methods of removal of FBs

  • Forceps or hook (round and smooth FBs may not be easy to remove using this method)

_May scoop with curette or remove with Schuknect extractor

  • Irrigation with warm normal saline or water (but not for batteries FBs!)
  • Suction catheter
  • Dermabond on a swab stick

## Indication for reference to the ENT specialist

  • Perforated tympanic membrane
  • In case the FB is an adhesive material that is in contact with the tympanic membrane
  • Failure to remove the FB
  • Where sedation is required e.g. in case of uncooperative patient
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