Chapter 46. Foreign Body Removal: External Auditory Canal

• • Foreign body lodged in the external auditory canal.

Absolute

• • Perforated tympanic membrane.

Relative

• • Inability to visualize the tympanic membrane.

• • 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 the head.

  • 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 grasp.

  • 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 ...