Difference between revisions of "Ear foreign body"

(Text replacement - "ciprofloxacin " to "ciprofloxacin ")
 
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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
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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]], 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
  
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*Right angle tool / day hook
 
*Right angle tool / day hook
 
*Scoop with curette (lighted curette helpful)
 
*Scoop with curette (lighted curette helpful)
*Schuknect extractor (attaches to wall suction)
+
*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
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===Antibiotics===
 
===Antibiotics===
*Ofloxacin or [[ciprofloxacin]] + dexamethasone if perforated TM or significant trauma to ear canal
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*[[Ofloxacin]] or [[ciprofloxacin]] + [[dexamethasone]] if perforated TM or significant trauma to ear canal
  
 
==Disposition==
 
==Disposition==
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==See Also==
 
==See Also==
 
*[[Foreign bodies]]
 
*[[Foreign bodies]]
 +
*[[Ear diagnoses]]
  
 
==External Links==
 
==External Links==
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[[Category:ENT]]
 
[[Category:ENT]]
 +
[[Category:Symptoms]]

Latest revision as of 15:06, 20 October 2019

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, 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

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