Foreign bodies in the ear

Quick management guide and extraction techniques for Pediatric Emergencies.

Extraction Techniques

Water Irrigation

First-line technique for inorganic objects that do not completely occlude the canal. Very well tolerated by pediatric patients.

Instrumentation (Curette/Hook)

Ideal for hard, round objects (beads, trinkets). Requires direct vision and excellent immobilization of the patient.

Use of Tweezers (Crocodile)

Reserved exclusively for soft, malleable objects or objects with irregular edges (paper, cotton, foam).

Extraction of Live Insects

The movement of the insect causes severe pain and panic. He must be euthanized or immobilized before any extraction is attempted.

Balloon Catheter/Suction

Use of pediatric Fogarty catheter or suction for smooth, spherical objects where solid instruments would slip.

Security Protocol

TO DO

  • Immobilize properly: Use a wrap-around sheet or restraint technique with the help of parents/nursing. It is the most critical step.
  • Ensure good lighting: Use an otoscope with a good battery or a binocular front mirror/magnifier if available.
  • Anesthetize insects: Use 2% lidocaine or mineral oil before trying to remove them.
  • Evaluate both ears and nose: Young children often introduce multiple objects.
  • Check the post-extraction duct: Rule out lacerations or residual tympanic perforation.

WHAT NOT TO DO

  • DO NOT irrigate button batteries: Water accelerates necrosis by liquefaction.
  • DO NOT irrigate organic material: Seeds, legumes or sponges expand with water and become more impacted.
  • DO NOT irrigate if there is tympanic perforation or history of ventilation tubes.
  • DO NOT use tweezers on round/hard objects: They will slip and push the object further to the bottom ("cherry pit" effect).
  • DO NOT insist after multiple attempts: Maximum 2-3 attempts in the emergency room so as not to traumatize or generate aversion.

ENT Referral Criteria

Indications for Referral (Consult Specialist)

Button battery: Absolute emergency. Risk of perforation in < 2 hours.
Foreign body firmly impacted in the ear canal.
Object in direct contact with the tympanic membrane.
Previous severe EAC trauma, significant laceration or bleeding.
Extremely uncooperative child or need for deep sedation/general anesthesia.
Failure after 2 or 3 extraction attempts in the emergency room.