Ear foreign body

Background

• 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
  • Auricular hematoma
  • Cholesteatoma
  • Contact dermatitis
  • Ear foreign body
  • Herpes zoster oticus (Ramsay Hunt syndrome)
  • Malignant otitis externa
  • Mastoiditis
  • Otitis externa
  • Otomycosis
  • Tympanic membrane rupture
• Internal
  • Acute otitis media
  • Bullous myringitis
  • Chronic otitis media
  • Mastoiditis
  • Otic barotrauma
• Inner/vestibular
  • Labyrinthitis
  • 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, 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
  • Attach 14 or 16 ga IV catheter to syringe
• Alligator forceps
• Right angle tool / day hook
• Scoop with curette (lighted curette helpful)
• Schuknect 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

References

Authors

Joe Carpenter, Ross Donaldson, Kelly Young, Michael Holtz, Neil Young