Ear foreign body

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

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
  • Otic barotrauma

Internal

• Acute otitis media
  • Bullous myringitis
• Chronic otitis media
• Mastoiditis

Inner/vestibular

• Labyrinthitis, vestibular neuritis
• Meniere's disease
• Sudden sensorineural hearing loss

Diagnosis

• Typically seen on visual inspection or otoscopy
• Check other ear / nares

Management

• Button battery
  • Removal ASAP in consultation with ENT
• Insect
  • Kill with mineral oil, EtOH, or 2% lidocaine prior to removal
• Penetrating FB's
  • Low threshold for ENT consult
  • Tympanic membrane rupture

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
• Schuknect extractor (attaches to wall suction)
• Dermabond on a swab stick
  • Allow glue to become tacky before inserting into canal

Antibiotics

• Ofloxacin if perforated TM or significant trauma to ear canal

Disposition

• Emergent ENT for all button batteries failing ED management
• Urgent ENT for TM injuries

See Also

• Foreign bodies

References

UpToDate, Tintinalli's, Roberts and Hedges