Ear foreign body: Difference between revisions
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==Background== | ==Background== | ||
[[File:Gray907.png|thumb|Ear anatomy]] | [[File:Gray907.png|thumb|Ear anatomy]] | ||
*Usually children 6 | *Usually children 6 years old or younger | ||
{{FB types}} | |||
==Clinical Features== | ==Clinical Features== | ||
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==Management== | ==Management== | ||
[[File:EarFB.jpg|thumb|Schema showing typical foreign body location in relation to ear canal.]] | |||
===General Removal Options=== | |||
===Removal=== | |||
*Irrigation | *Irrigation | ||
**Contraindicated if suspected TM perforation, tympanostomy tubes, button battery, or vegetable parts (swells) | **Contraindicated if suspected [[TM perforation]], tympanostomy tubes, button battery, or vegetable parts (swells) | ||
**Body temperature sterile water or normal saline | **Body temperature sterile water or normal saline to avoid inducing nystagmus | ||
**Attach 14 or 16 ga IV catheter to 20-60 mL syringe | **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 | **Can also utilize an infant nasogastric tube instead of an IV catheter, place tip of catheter next to TM, connect syringe and irrigate | ||
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*Scoop with curette (lighted curette helpful) | *Scoop with curette (lighted curette helpful) | ||
*Schuknecht extractor (attaches to wall suction) | *Schuknecht extractor (attaches to wall suction) | ||
*Dermabond on a swab stick | *Dermabond on a swab stick<ref>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</ref> | ||
**Allow glue to become tacky before inserting into canal | **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 | **May use disposable ear speculum to shield canal so do not accidentally glue stick to ear canal | ||
===Antibiotics=== | ===Antibiotics=== | ||
*[[ | *Consider [[ofloxacin]] or [[ciprofloxacin]] +/- [[dexamethasone]] if [[perforated TM]] or significant trauma to ear canal | ||
===Insects=== | |||
*May wish to first kill (e.g., with mineral oil, [[EtOH]], diluted hydrogen peroxide, or 2% [[lidocaine]]) prior to removal | |||
*In an in-vitro trial mineral oil was faster and more effective than other methods to kill cockroaches<ref>Leffler, S., Cheney, P., & Tandberg, D. (1993). Chemical immobilization and killing of intra-aural roaches: an in vitro comparative study. Annals of emergency medicine, 22(12), 1795–1798. https://doi.org/10.1016/s0196-0644(05)80402-0</ref> | |||
*Sometimes use of killing agents may make insects soft and mushy, thus making it more difficult to remove all pieces. In this case, may consider irrigation afterwards, to remove all parts. Or, may alternatively defer injection of liquid and prefer swift removal, if a viable option (e.g., with a compliant, non-pediatric patient) | |||
===Button Batteries=== | |||
*Requires emergent removal (consider ENT consult) | |||
==Disposition== | ==Disposition== | ||
*Most patients with foreign body removal and no significant complications can be discharged | |||
*Consider urgent ENT consult/follow-up for TM injuries, retained FB, retained insect parts | |||
*Emergent ENT for all button batteries failing ED management | *Emergent ENT for all button batteries failing ED management | ||
* | |||
==Complications== | |||
*[[Tympanic membrane rupture]] | |||
==See Also== | ==See Also== | ||
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==External Links== | ==External Links== | ||
*[https://www.aliem.com/pem-search-rescue-ear-foreign-bodies/ ALiEM: PEM Pearls: Search & Rescue of Ear Foreign Bodies – Picking the Right Tool] | |||
==References== | ==References== | ||
Latest revision as of 20:33, 26 July 2023
Background
- Usually children 6 years old 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
General Removal Options
- 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
- Consider ofloxacin or ciprofloxacin +/- dexamethasone if perforated TM or significant trauma to ear canal
Insects
- May wish to first kill (e.g., with mineral oil, EtOH, diluted hydrogen peroxide, or 2% lidocaine) prior to removal
- In an in-vitro trial mineral oil was faster and more effective than other methods to kill cockroaches[2]
- Sometimes use of killing agents may make insects soft and mushy, thus making it more difficult to remove all pieces. In this case, may consider irrigation afterwards, to remove all parts. Or, may alternatively defer injection of liquid and prefer swift removal, if a viable option (e.g., with a compliant, non-pediatric patient)
Button Batteries
- Requires emergent removal (consider ENT consult)
Disposition
- Most patients with foreign body removal and no significant complications can be discharged
- Consider urgent ENT consult/follow-up for TM injuries, retained FB, retained insect parts
- Emergent ENT for all button batteries failing ED management
Complications
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
- ↑ Leffler, S., Cheney, P., & Tandberg, D. (1993). Chemical immobilization and killing of intra-aural roaches: an in vitro comparative study. Annals of emergency medicine, 22(12), 1795–1798. https://doi.org/10.1016/s0196-0644(05)80402-0