Ear foreign body: Difference between revisions
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==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) | ||
* | *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 | *[[Ofloxacin]] or [[ciprofloxacin]] + [[dexamethasone]] if perforated TM or significant trauma to ear canal | ||
==Disposition== | ==Disposition== | ||
Revision as of 20:50, 30 September 2019
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)
- 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
- 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