Ear foreign body: Difference between revisions

No edit summary
(14 intermediate revisions by 6 users not shown)
Line 1: Line 1:
==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
Line 12: Line 13:
{{Ear DDX}}
{{Ear DDX}}


==Diagnosis==
==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)
**Removal ASAP in consultation with ENT
*Insect - Kill with mineral oil, [[EtOH]], diluted hydrogen peroxide, or 2% [[lidocaine]] prior to removal
*Insect
*[[Tympanic membrane rupture|Penetrating FB's]] - Have a low threshold for ENT consult
**Kill with mineral oil, EtOH, or 2% lidocaine prior to removal
*Penetrating FB's
**Low threshold for ENT consult
**[[Tympanic membrane rupture]]


===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)
**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
*Schuknect extractor (attaches to wall suction)
*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==
Line 52: Line 54:


[[Category:ENT]]
[[Category:ENT]]
[[Category:Symptoms]]

Revision as of 19:14, 15 April 2020

Background

Ear anatomy
  • 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

Internal

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

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

External Links

References