Ear foreign body: Difference between revisions
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==Background== | ==Background== | ||
[[File:Gray907.png|thumb|Ear anatomy]] | |||
*Usually children 6 yo or younger | *Usually children 6 yo or younger | ||
==Clinical Features== | ==Clinical Features== | ||
*Caregiver often reports seeing child put something in the ear | *Caregiver often reports seeing child put something in the ear | ||
*Decreased hearing or otalgia | *[[hearing loss|Decreased hearing]] or [[earache|otalgia]] | ||
*More common on right (hand dominant) side | *More common on right (hand dominant) side | ||
*May have otorrhea or bleeding | *May have otorrhea or bleeding | ||
*Foreign body contacting tympanic membrane can cause intractable [[Hiccups|hiccups]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Ear DDX}} | {{Ear DDX}} | ||
== | ==Evaluation== | ||
*Typically seen on visual inspection or otoscopy | *Typically seen on visual inspection or otoscopy | ||
*Check other ear / nares | *Check other ear / nares | ||
==Management== | ==Management== | ||
*Button battery | *Button battery - Requires emergent removal (in consultation with ENT) | ||
*Insect - Kill with mineral oil, [[EtOH]], or 2% [[lidocaine]] prior to removal | |||
*Insect | *[[Tympanic membrane rupture|Penetrating FB's]] - Have a low threshold for ENT consult | ||
*Penetrating FB's | |||
===Removal=== | ===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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*Alligator forceps | *Alligator forceps | ||
*Right angle tool / day hook | *Right angle tool / day hook | ||
* | *Scoop with curette (lighted curette helpful) | ||
*Schuknecht extractor (attaches to wall suction) | |||
*Dermabond on a swab stick | *Dermabond on a swab stick | ||
**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 | |||
===Antibiotics=== | ===Antibiotics=== | ||
*Ofloxacin if perforated TM or significant trauma to ear canal | *[[Ofloxacin]] or [[ciprofloxacin]] + [[dexamethasone]] if perforated TM or significant trauma to ear canal | ||
==Disposition== | ==Disposition== | ||
*Emergent ENT for all button batteries failing ED management | *Emergent ENT for all button batteries failing ED management | ||
*Urgent ENT for TM injuries | *Urgent ENT consult/follow-up for TM injuries, retained FB, retained insect parts | ||
==See Also== | ==See Also== | ||
*[[Foreign bodies]] | *[[Foreign bodies]] | ||
*[[Ear diagnoses]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | |||
[[Category:ENT]] | |||
[[Category:Symptoms]] | |||
Revision as of 15:06, 20 October 2019
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
- 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
- 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)
- Schuknecht 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