II. Causes
- Insects
- Plastic toys or beads
- Cotton, paper
- Organic material such as popcorn kernals or vegetable material
- Higher risk of infection
- Small batteries (may be caustic!, especially button batteries)
- Require removal without delay
III. Symptoms
IV. Precautions
- Removal risks Tympanic Membrane injury
- First attempts at removal are most likely to succeed
- Best succes is for graspable objects (e.g. paper)
- Risk of ear canal injury and further impaction of foreign body increases with repeat attempt
V. Management
- Conscious Sedation may be needed in young children
- Kill any live Insects before attempting removal
- Rubbing Alcohol or
- Lidocaine 2% or
- Mineral Oil
- Instruments and Methods
- Removal under direct visualization
- Use otoscope with operative otoscope head (allows a larger channel for instrumentation)
- Micro Alligator Forceps: Remove graspable foreign body
- More difficult if round, smooth object, in canal for >24 hours, or adjacent to Tympanic Membrane
- Cerumen curettes
- The small blue plastic Ear Curettes with its narrow caliber may more easily pass behind the foreign body
- Plastic curettes are maleable and the end may be bent to catch the backside of the foreign body
- Ear Irrigation
- Do not use in Button Battery foreign body
- Caustic, alkaline materials will leach out of the battery when wet
- Do not use if organic foreign body
- Organic objects that absorb water (e.g. beens) will swell with irrigation, making removal difficult
- Do not use in Button Battery foreign body
- Katz Extractor
- Suction catheter
- Exercise caution due to risk of Tympanic Membrane Rupture and ossicle damage
- Typically defer Ear Suction to otolaryngology
- Use a small catheter tip (e.g. dental suction, "little sucker" pediatric suction tip or Fraser Suction Catheter)
- Use the lowest effective suction strength
- Tissue Adhesive technique (using Dermabond or cyanoacrylate)
- Indicated for dry, hard, non-organic foreign bodies
- Apply a drop of Tissue Adhesive to the wooden end of a cotton applicator (e.g. similar to q-tip)
- Under direct visualization, apply the freshly glued, wooden tip to the foreign body
- Hold the applicator tip against the surface of the foreign body for 30 seconds
- Carefully withdraw both the applicator and the foreign body as a unit from the ear canal
- Lin in Herbert (2015) EM:Rap 15(2): 6-7
- Removal under direct visualization
- Other measures
- Acetone dissolves styrofoam and super glue
- Otic Antibiotic drops indicated for concurrent Otitis Externa or ear canal Trauma
VI. Management: Referral
- Most foreign bodies may be safely deferred to ENT for removal in 1-2 days
- Batteries (esp. button batteries) and magnets should be removed emergently (local necrosis risk)
- Referral Indications
- Young or developmentally delayed patients requiring Conscious Sedation
- Ear canal Lacerations, Tympanic Membrane injury or other Trauma on attempted removal
- Foreign body refractory to removal attempts (e.g. impacted in canal, posterior or hidden)
- Sharp, penetrating or hooked foreign body
VII. References
- Claudius and Brown (2017) Crit Dec Emerg Med 31(12): 13-20
- Claudius, Behar and Stoner in Herbert (2015) EM:Rap 15(11):2-3
- Ansley (1998) Pediatrics 101: 638-41 [PubMed]
- DiMuzio (2002) Otol Neurotal 23:473-5 [PubMed]
- Heim (2007) Am Fam Physician 76: 1185-9 [PubMed]
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Related Studies
| Concepts | Injury or Poisoning (T037) |
| ICD9 | 931 |
| ICD10 | T16 |
| SnomedCT | 157552003, 211623003, 75441006, 32874004 |
| English | Foreign body in ear NOS, FB-For body EAC-ext aud can, Foreign body in EAC, foreign body in external ear canal, foreign body in external auditory canal (physical finding), foreign body in external auditory canal, foreign body of ear (diagnosis), foreign body of ear, external auditory canal foreign body, Foreign body retained in ear, foreign body ear, Foreign body (in);ear, foreign body in ear, body ear foreign, bodies ear foreign, ear foreign body, foreign body in auditory canal, Foreign body in ear NOS (disorder), Foreign body in ear, Foreign body in auditory canal, FB - Foreign body in EAC - external auditory canal, Foreign body in external auditory canal, Foreign body in auditory canal (disorder), Foreign body in ear (disorder), auditory canal; foreign body, ear; foreign body, foreign body; auditory canal, foreign body; ear |
| Korean | 귀의 이물 |
| Spanish | Cuerpo extraño retenido en el oído, Cuerpo extraño en oído, cuerpo extraño en oído, SAI, cuerpo extraño en oído, SAI (trastorno), cuerpo extraño en el conducto auditivo (trastorno), cuerpo extraño en el conducto auditivo, cuerpo extraño en el oído (trastorno), cuerpo extraño en el oído |
| Portuguese | Corpo estranho no ouvido, Corpo estranho retido no ouvido |
| Italian | Corpo estraneo ritenuto nell'orecchio, Corpo estraneo nell'orecchio |
| German | Fremdkoerper im Ohr |
| French | Corps étranger dans l'oreille, Corps étranger du conduit auditif externe |
| Czech | Cizí těleso v uchu, Cizí těleso uvízlé v zevním zvukovodu |
| Dutch | vreemd lichaam in oor, vreemd lichaam achtergebleven in oor, Corpus alienum in oor, corpus alienum; gehoorgang, corpus alienum; oor, gehoorgang; corpus alienum, oor; corpus alienum |
| Japanese | ｼﾞﾅｲｲﾌﾞﾂ, 耳内異物 |
| Hungarian | Idegentest a fülben, Retineált idegentest a fülben |
