Ear foreign body: Difference between revisions
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{{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 | ||
| Line 28: | Line 28: | ||
*Alligator forceps | *Alligator forceps | ||
*Right angle tool / day hook | *Right angle tool / day hook | ||
*Scoop with curette (lighted curette helpful) | |||
*Schuknect extractor (attaches to wall suction) | *Schuknect 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 consult/follow-up for TM injuries | *Urgent ENT consult/follow-up for TM injuries, retained FB, retained insect parts | ||
==See Also== | ==See Also== | ||
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
- 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)
- 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