• Alligator forceps.
• Simple forceps.
• Ear curette (metal or plastic).
• Right-angle hook.
• Irrigation setup (water pik device or 20–60-mL syringe attached
to cut-off butterfly tubing or angiocatheter).
• Otoscope with operating head.
• Lidocaine spray or viscous lidocaine suspension.
• Frazier tip or Schuknecht suction.
• Cyanoacrylate glue adhesive.
• Failed removal (20–30%).
• Canal laceration or bleeding (10–50%).
• Psychological stress (common; child is restrained for procedure).
• Perforation of the tympanic membrane (1–2%).
• Damage to the ossicles (< 1%).
• If the child cannot be adequately restrained,
do not attempt removal.
• Most foreign bodies do not require urgent removal, and the child
can be referred to an otolaryngologist if efforts fail.
• Never use irrigation to remove disc batteries, vegetable matter,
or expansible objects (eg, sponge).
• Hard spherical objects can be difficult to remove. Do not use
forceps because they may push the object further into the canal.
• Sharp objects pose a higher risk of tympanic membrane perforation.
Proceed with caution or refer to an otolaryngologist for removal
with an operating microscope.
• The first attempt is the best attempt. Repeated attempts with
a struggling child are not likely to be successful.
• Test for and document any dizziness or hearing loss before removal
attempts. Document an additional examination after the foreign body
has been removed.
• Reassure the child that no needles will be used.
• Show the child the instrument that you are going to use and let
him or her feel that it is not sharp.
• Explain that holding still is extremely important in order to
minimize the likelihood of pain.
• A toddler may be restrained in the parent’s
lap, facing the parent, with the head turned to 1 side and pressed
up against the parent’s chest.
• The parent then gives the child a bear hug, wrapping 1 arm around
the patient’s body and arms and the other arm restraining
• It is important that the head be fully turned because the child
has less strength in this position to break free from the parent’s
• An older child should be placed supine on the examining table,
with the head turned so that the affected ear is facing up.
• Immobilization of the head by an assistant is recommended, even
if the child appears cooperative.
• The inner two-thirds of the external auditory canal is exquisitely
sensitive to pain. With even minor manipulation, the child may suddenly
jerk his or her head, causing trauma to the external auditory canal.
• If the child is uncooperative, the shoulders and torso need to
be restrained as well.
• A parent or assistant may assume a position at the ...
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