Difference between revisions of "Ear foreign body"

(Differential Diagnosis)
(Text replacement - "ciprofloxacin " to "ciprofloxacin ")
 
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==Background==
 
==Background==
 +
*Usually children 6 yo or younger
  
 
==Clinical Features==
 
==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|hiccups]]
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 
{{Ear DDX}}
 
{{Ear DDX}}
  
==Diagnosis==
+
==Evaluation==
 +
*Typically seen on visual inspection or otoscopy
 +
*Check other ear / nares
  
 
==Management==
 
==Management==
 +
*Button battery - Requires emergent removal (in consultation with ENT)
 +
*Insect - Kill with mineral oil, EtOH, or 2% lidocaine prior to removal
 +
*[[Tympanic membrane rupture|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)
 +
*Schuknect 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==
 
==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==
 
==See Also==
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==External Links==
 
==External Links==
 +
  
 
==References==
 
==References==
 
<references/>
 
<references/>
 +
 +
[[Category:ENT]]

Latest revision as of 13:56, 6 August 2016

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

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, 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)
  • Schuknect 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

See Also

External Links

References