Society for Pediatric Urgent Care

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Society for Pediatric Urgent Care

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Foreign Body Ear

ALERTS

Button Batteries need immediate removal
Sharp object such as glass can lacerate canal
Live insects can cause extreme discomfort
Food items absorb moisture which can lead to inflammation/infection
 

AGE

Typical age between 3 and 8 years
 

DIFFERENTIAL DIAGNOSIS

Cerumen impaction
Abrasion to ear canal
Otitis Externa
Tumor
 

EVALUATION

History

Patient may admit to placing something in ear
Parents witness placement
Symptoms of otalgia or otorrhea
Patient feels extreme discomfort in ear (insect)
 

Physical Exam

Examine both ear canals for foreign bodies
Examine nares for foreign bodies
Look for live insect, any signs of infection or any bleeding
 

Diagnostic findings

Visualization of foreign body in ear canal
 

Diagnostic Tests & Interpretation

Not necessary
 

MANAGEMENT

Removal

Young and uncooperative patients must be immobilized for successful removal
All of these methods may push object deeper into canal

  • Irrigation
    • warm water flushed into canal with 20 ml syringe attached to a flexible IV catheter tip contraindicated with TM perforation, food matter, or disc batteries
  • Instrumentation- best for objects in the lateral 1/3 of the canal
    • Alligator forceps or Hartman forceps- look for an edge to grab foreign body and withdraw
    • Ear Curette-visualize FB with otoscope pass curette beyond FB and withdraw
  • Katz Extractor
    • insert catheter past FB, push on syringe to inflate small balloon and extract
  • Suction- usually not successful

Insect removal requires insect to be killed before removal with insertion of mineral oil or Auralgan drops into canal

Treatment

  • Patients who undergo uncomplicated removal do not need any follow up care
  • Antibiotic drops
    • Patients who sustained any abrasion or irritation of canal during removal procedure should receive antibiotic drops
    • Floxin Otic- 2 drops affected ear BID for 7 days
  • Surgery / Other Procedures
    • OR with sedation for difficult removals or uncooperative patient

ENT Referral

  • Out patient
    • failure to remove
    • significant injury to canal
    • perforated TM
    • object is wedged in canal or against the TM
  • Immediate consult
    • Disc battery
    • Glass or sharp object
    • Liquefaction necrosis

Written instructions should include:

Anticipatory Guidance

  • Analgesics as necessary
    • PMD follow up in 2-3 days to asses for healing

Activity

  • No swimming or getting water into canal until ear is healed

Signs and Symptoms to return

  • Ear drainage
    • Worsening ear pain

PROGNOSIS, COMPLICATIONS

 

REFERENCES

1.Ansley JF, Cunningham MJ. Treatment of Aural Foreign Bodies in Children. Pediatrics 1998;101(4):638-640
2.Fritz S, Kelen GD Foreign Bodies of the External Auditory Canal. Emerg Med Clin North Amer 1987;(5):183-192

 

ADDITIONAL RESOURCES

 

SEE ALSO (Topic, Algorithm, Electronic Media Element)

 

CODES

ICD9

PUBLISHER WILL ENTER

Snomed

PUBLISHER WILL ENTER