Ear foreign body: Difference between revisions
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==Management== | ==Management== | ||
*Button battery - Requires emergent removal (in consultation with ENT) | *Button battery - Requires emergent removal (in consultation with ENT) | ||
*Insect - Kill with mineral oil, [[EtOH]], or 2% [[lidocaine]] prior to removal | *Insect - Kill with mineral oil, [[EtOH]], diluted hydrogen peroxide, or 2% [[lidocaine]] prior to removal | ||
*[[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 | ||
| Line 25: | Line 25: | ||
*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 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 | |||
*Alligator forceps | *Alligator forceps | ||
*Right angle tool / day hook | *Right angle tool / day hook | ||
Revision as of 19:14, 15 April 2020
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, diluted hydrogen peroxide, 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 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
- 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