Ear foreign body - Revision history

Rossdonaldson1: /* Disposition */

2023-07-26T20:33:53Z

Disposition

← Older revision		Revision as of 20:33, 26 July 2023
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	==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
	*Urgent ENT consult/follow-up for TM injuries, retained FB, retained insect parts

	==Complications==		==Complications==

Rossdonaldson1: /* General Removal Options */

2023-07-26T20:14:12Z

General Removal Options

← Older revision		Revision as of 20:14, 26 July 2023
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	===General Removal Options===		===General Removal Options===
	*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 to avoid inducing nystagmus		**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

Rossdonaldson1: /* Management */

2023-07-26T20:13:41Z

Management

← Older revision		Revision as of 20:13, 26 July 2023
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	**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

	===~~Button battery~~===		===Antibiotics===
	*~~Requires emergent removal (consider ENT consult)~~		*Consider [[ofloxacin]] or [[ciprofloxacin]] +/- [[dexamethasone]] if [[perforated TM]] or significant trauma to ear canal

	===~~Insect~~===		===Insects===
	*May wish to first kill (e.g., with mineral oil, [[EtOH]], diluted hydrogen peroxide, or 2% [[lidocaine]]) prior to removal		*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>		*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)		*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)

	===~~Antibiotics~~===		===Button Batteries===
	*~~[[Ofloxacin]] or [[ciprofloxacin]] + [[dexamethasone]] if perforated TM or significant trauma to ear canal~~		*Requires emergent removal (consider ENT consult)

	==Disposition==		==Disposition==

Rossdonaldson1: /* Management */

2023-07-26T20:12:12Z

Management

← Older revision		Revision as of 20:12, 26 July 2023
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	==Management==		==Management==
	[[File:EarFB.jpg\|thumb\|Schema showing typical foreign body location in relation to ear canal.]]		[[File:EarFB.jpg\|thumb\|Schema showing typical foreign body location in relation to ear canal.]]
	*Button battery		===General Removal Options===
	**Requires emergent removal (consider ENT consult)
	*Insect
	**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)

	===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)
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	**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

			===Button battery===
			*Requires emergent removal (consider ENT consult)

			===Insect===
			*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)

	===Antibiotics===		===Antibiotics===

Rossdonaldson1 at 20:09, 26 July 2023

2023-07-26T20:09:50Z

← Older revision		Revision as of 20:09, 26 July 2023
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	**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>		**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)		**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)
	*[[Tympanic membrane rupture\|Penetrating FB's]]
	**Have a low threshold for ENT consult

	===Removal===		===Removal===
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	*Emergent ENT for all button batteries failing ED management		*Emergent ENT for all button batteries failing ED management
	*Urgent ENT consult/follow-up for TM injuries, retained FB, retained insect parts		*Urgent ENT consult/follow-up for TM injuries, retained FB, retained insect parts

			==Complications==
			*[[Tympanic membrane rupture]]

	==See Also==		==See Also==

Rossdonaldson1: /* Management */

2023-07-26T20:08:46Z

Management

← Older revision		Revision as of 20:08, 26 July 2023
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	==Management==		==Management==
	[[File:EarFB.jpg\|thumb\|Schema showing typical foreign body location in relation to ear canal.]]		[[File:EarFB.jpg\|thumb\|Schema showing typical foreign body location in relation to ear canal.]]
	*Button battery - Requires emergent removal (~~in consultation with~~ ENT)		*Button battery
	*Insect ~~- Kill~~ with mineral oil, [[EtOH]], diluted hydrogen peroxide, or 2% [[lidocaine]] prior to removal		**Requires emergent removal (consider ENT consult)
			*Insect
			**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>		**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>
	*[[Tympanic membrane rupture\|Penetrating FB's]] - Have a low threshold for ENT consult		**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)
			*[[Tympanic membrane rupture\|Penetrating FB's]]
			**Have a low threshold for ENT consult

	===Removal===		===Removal===

Rossdonaldson1: /* Management */

2023-07-26T20:05:28Z

Management

← Older revision		Revision as of 20:05, 26 July 2023
Line 20:		Line 20:

	==Management==		==Management==
			[[File:EarFB.jpg\|thumb\|Schema showing typical foreign body location in relation to ear canal.]]
	*Button battery - Requires emergent removal (in consultation with ENT)		*Button battery - Requires emergent removal (in consultation with ENT)
	*Insect - Kill with mineral oil, [[EtOH]], diluted hydrogen peroxide, or 2% [[lidocaine]] prior to removal		*Insect - Kill with mineral oil, [[EtOH]], diluted hydrogen peroxide, or 2% [[lidocaine]] prior to removal

Rossdonaldson1: /* Background */

2023-07-26T19:31:51Z

Background

← Older revision		Revision as of 19:31, 26 July 2023
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	==Background==		==Background==
	[[File:Gray907.png\|thumb\|Ear anatomy]]		[[File:Gray907.png\|thumb\|Ear anatomy]]
	*Usually children 6 yo or younger		*Usually children 6 years old or younger

	{{FB types}}		{{FB types}}

Zbuchwald: /* Management */

2023-07-10T02:57:27Z

Management

← Older revision		Revision as of 02:57, 10 July 2023
Line 22:		Line 22:
	*Button battery - Requires emergent removal (in consultation with ENT)		*Button battery - Requires emergent removal (in consultation with ENT)
	*Insect - Kill with mineral oil, [[EtOH]], diluted hydrogen peroxide, or 2% [[lidocaine]] prior to removal		*Insect - Kill with mineral oil, [[EtOH]], diluted hydrogen peroxide, or 2% [[lidocaine]] prior to removal
	**In an in-vitro trial mineral 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>		**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>
	*[[Tympanic membrane rupture\|Penetrating FB's]] - Have a low threshold for ENT consult		*[[Tympanic membrane rupture\|Penetrating FB's]] - Have a low threshold for ENT consult

Zbuchwald: /* Management */

2023-07-10T02:55:36Z

Management

← Older revision		Revision as of 02:55, 10 July 2023
Line 22:		Line 22:
	*Button battery - Requires emergent removal (in consultation with ENT)		*Button battery - Requires emergent removal (in consultation with ENT)
	*Insect - Kill with mineral oil, [[EtOH]], diluted hydrogen peroxide, or 2% [[lidocaine]] prior to removal		*Insect - Kill with mineral oil, [[EtOH]], diluted hydrogen peroxide, or 2% [[lidocaine]] prior to removal
			**In an in-vitro trial mineral 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>
	*[[Tympanic membrane rupture\|Penetrating FB's]] - Have a low threshold for ENT consult		*[[Tympanic membrane rupture\|Penetrating FB's]] - Have a low threshold for ENT consult