Chapter 24: Ear—Foreign Body

Patient Story

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.

Introduction

• 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.

Epidemiology

• Ear FBs are commonly seen in children aged 1 to 6 years.^1–3

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

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.

Risk Factors

• 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

Diagnosis

Clinical Features

• Key historical features include:

  ...