Ear Canal Foreign Body

Aka: Ear Canal Foreign Body, Ear Foreign Body, Auditory Canal Foreign Body

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II. Causes

  1. Insects
  2. Plastic toys or beads
  3. Cotton, paper
  4. Organic material such as popcorn kernals or vegetable material
    1. Higher risk of infection
  5. Small batteries (may be caustic!, especially button batteries)
    1. Require removal without delay

III. Symptoms

  1. Ear Pain

IV. Precautions

  1. Removal risks Tympanic Membrane injury
  2. First attempts at removal are most likely to succeed
    1. Best succes is for graspable objects (e.g. paper)
  3. Risk of ear canal injury and further impaction of foreign body increases with repeat attempt

V. Management

  1. Conscious Sedation may be needed in young children
  2. Kill any live Insects before attempting removal
    1. Rubbing Alcohol or
    2. Lidocaine 2% or
    3. Mineral Oil
  3. Instruments and Methods
    1. Removal under direct visualization
      1. Use otoscope with operative otoscope head (allows a larger channel for instrumentation)
      2. Micro Alligator Forceps: Remove graspable foreign body
      3. More difficult if round, smooth object, in canal for >24 hours, or adjacent to Tympanic Membrane
    2. Cerumen curettes
    3. Ear Irrigation
      1. Do not use in Button Battery foreign body
        1. Caustic, alkaline materials will leach out of the battery when wet
      2. Do not use if organic foreign body
        1. Organic objects that absorb water (e.g. beens) will swell with irrigation, making removal difficult
    4. Katz Extractor
      1. http://www.inhealth.com/category_s/49.htm
    5. Suction catheter
      1. Exercise caution due to risk of Tympanic Membrane Rupture and ossicle damage
      2. Typically defer Ear Suction to otolaryngology
      3. Use a small catheter tip (e.g. dental suction, "little sucker" pediatric suction tip or Fraser Suction Catheter)
      4. Use the lowest effective suction strength
    6. Tissue Adhesive technique (using Dermabond or cyanoacrylate)
      1. Indicated for dry, hard, non-organic foreign bodies
      2. Apply a drop of Tissue Adhesive to the wooden end of a cotton applicator (e.g. similar to q-tip)
      3. Under direct visualization, apply the freshly glued, wooden tip to the foreign body
      4. Hold the applicator tip against the surface of the foreign body for 30 seconds
      5. Carefully withdraw both the applicator and the foreign body as a unit from the ear canal
      6. Lin in Herbert (2015) EM:Rap 15(2): 6-7
  4. Other measures
    1. Acetone dissolves styrofoam and super glue
    2. Otic Antibiotic drops indicated for concurrent Otitis Externa or ear canal Trauma

VI. Management: Referral

  1. Most foreign bodies may be safely deferred to ENT for removal in 1-2 days
    1. Batteries (esp. button batteries) and magnets should be removed emergently (local necrosis risk)
  2. Referral Indications
    1. Young or developmentally delayed patients requiring Conscious Sedation
    2. Ear canal Lacerations, Tympanic Membrane injury or other Trauma on attempted removal
    3. Foreign body refractory to removal attempts (e.g. impacted in canal, posterior or hidden)
    4. Sharp, penetrating or hooked foreign body

VII. References

  1. Claudius and Brown (2017) Crit Dec Emerg Med 31(12): 13-20
  2. Claudius, Behar and Stoner in Herbert (2015) EM:Rap 15(11):2-3
  3. Ansley (1998) Pediatrics 101: 638-41 [PubMed]
  4. DiMuzio (2002) Otol Neurotal 23:473-5 [PubMed]
  5. Heim (2007) Am Fam Physician 76: 1185-9 [PubMed]

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