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Patient Story
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A 3-year-old girl is brought by her parents to an urgent care facility after a day of crying, irritability, scant otorrhea, and frequent pulling of her right ear. Otoscopy reveals an erythematous, swollen external auditory canal (EAC) where a bead is wedged (Figure 24-1). The patient is referred to an otolaryngologist and the bead is removed using an operating microscope for visualization.

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FIGURE 24-1

Foreign body (bead) in the ear canal of a 3-year-old girl with reactive tissue around it. (Used with permission from William Clark, MD.)

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Introduction
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  • Children with ear foreign bodies (FBs) usually present with otalgia, otorrhea, or decreased hearing. At times, symptoms may be nonspecific, like irritability and crying. Other times, presentation may be asymptomatic.

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Epidemiology
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  • Ear FBs are commonly seen in children aged 1 to 6 years.13

  • Equal male-to-female ratio in the pediatric population.4

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Etiology and Pathophysiology
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  • Most common FBs in children include:5

  • Pathogenesis includes some of the key elements of otitis externa (see Chapter 21, Otitis Externa):

    • Initial breakdown of the skin-cerumen barrier (caused by presence of FB).

    • Skin inflammation and edema leading to subsequent obstruction of adnexal structures (e.g., cerumen glands, sebaceous glands, and hair follicles).

    • FB reaction leading to further skin injury.

    • In the case of alkaline battery electrochemical reaction, severe alkaline burns may occur.

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FIGURE 24-2

Piece of a crayon in the ear canal of a 4-year-old boy. (Used with permission from William Clark, MD.)

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FIGURE 24-3

Beach sand granules with exostosis in the ear of a cold water surfer. The exostoses are common in cold water swimmers and surfers. (Used with permission from Roy F. Sullivan, PhD. Audiology Forum: Video Otoscopy, www.rcsullivan.com.)

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FIGURE 24-4

Ant in the ear canal. (Used with permission from Vladimir Zlinsky, MD in Roy F. Sullivan, PhD. Audiology Forum: Video Otoscopy, www.rcsullivan.com.)

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Risk Factors
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  • Children with attention deficit hyperactivity disorder (ADHD) may be more likely to self-insert FBs and ADHD should be considered in children with ear FBs who are older than age 5 years.6

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Diagnosis
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Clinical Features
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  • Key historical features ...

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