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.
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.)
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.
Etiology and Pathophysiology
Most common FBs in children include:5
Inanimate objects such as beads (Figure 24-1), cotton tips, paper, toy parts, crayons (Figure 24-2), eraser tips, food, or organic matter, including sand (Figure 24-3), sticks, and stones.
Insects (Figure 24-4).
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.
Piece of a crayon in the ear canal of a 4-year-old boy. (Used with permission from William Clark, MD.)
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.)
Ant in the ear canal. (Used with permission from Vladimir Zlinsky, MD in Roy F. Sullivan, PhD. Audiology Forum: Video Otoscopy, www.rcsullivan.com.)