Introduction
The external ear canal (the tube that connects the outer ear to the middle ear) is the most prone location for the entrapment of foreign bodies. The external ear canal is almost straight in a child and gradually grows to around 2.5 to 3 centimeters long till nine years of age. Accidental entrapment of the foreign bodies in the ear, nose, and throat is very common among children but can also be seen in adults in a few cases. Removing foreign bodies from the ear needs adequate precision and is technique sensitive. Usually, patients report to the hospital immediately due to underlying discomfort. In a few cases, due to no presenting symptoms and unnoticed events, it results in delayed diagnosis and treatment.
What Is the Incidence of the Presence of a Foreign Body in the Ear?
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Accidental entrapment of a foreign body is quite common in children.
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Foreign bodies are associated mostly with the external ear canal for around 45 percent of the cases of the total pediatric (child) population.
What Are the Types of Foreign Bodies Usually Entrapped in the Ear Canal?
Various objects that may be stuck in the ear canal are as follows:
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Insects.
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Toys.
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Buttons.
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Piece of crayons.
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Small batteries.
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Tissue papers.
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Cotton balls.
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Hearing aid pieces.
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Beads.
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Food particles.
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Clay.
What Are the Signs and Symptoms Associated With the Presence of a Foreign Body?
Signs and symptoms associated with the presence of a foreign body are:
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Infection.
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Ear swelling.
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Ulceration.
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Bleeding from the ears.
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Ear fullness.
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A sensation of the presence of a foreign body in the ears.
But in some cases, it may be asymptomatic.
How to Diagnose Foreign Bodies Lodged in the Ears?
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History and Clinical Examination: The history of the presenting symptoms is recorded. Clinical examination is done by an ENT (ear, nose, and throat) specialist using an otoscope (an apparatus with attached light used to check ears) by making a child sit in a still position or taking the help of parents in maintaining a still position of a child if required to prevent movement of the object within the ears and for clear visibility.
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Hearing Assessment: A hearing assessment is done to rule out any hearing loss, involvement of the tympanic membrane, and eardrum perforation.
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Tuning Fork Test: It is done to rule out the type and severity of the hearing loss present.
How Is Ear Foreign Body Removal Performed in Emergency Medicine?
Removing a foreign body from the ears depends on the external object's location, type, size, and shape.
Types of Equipment Required:
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Ear probes.
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Alligator forceps (hook-like instrument).
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A balloon catheter (a long tube with an inflated balloon attached to the tip).
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Frazier suction tips (used to suck the foreign object out with air pressure).
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Binoculars.
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Right-angled hooks.
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Magnetic tipped rod.
Manual Technique of Ear Foreign Body Removal:
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The outer ear is retracted to increase the visibility of the external ear canal. The location and size of the foreign body are assessed using the otoscope (apparatus with attached light). A right-angled hook or ear probe is placed cautiously behind the foreign body and is rotated outwards for removal.
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In case of a button battery or magnetic objects stuck in the ear, a telescopic magnetic tipped to pick up tool is used to retrieve the foreign object from the ear.
Irrigation:
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It is another method to remove the foreign body from the ears. A catheter (a long thin tube) is placed behind the foreign body, and water at body temperature is used for flushing the foreign particle out.
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Irrigation is not indicated in cases of a perforated eardrum.
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The irrigation technique is contraindicated in case there are chances of foreign particles absorbing water and swelling, further blocking the ears like a sponge.
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Irrigation with too hot or cold water can lead to nausea, vomiting, and vertigo symptoms.
Suction:
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A Frazier suction tip is placed safely against the foreign body and is retrieved from the ears.
Cyanoacrylate (Superglue):
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Superglue is placed on a wooden end of a cotton-tipped applicator. The glue-tipped applicator is then lightly placed on a foreign body for around 15 seconds and retrieved from the ears.
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Caution should be used to avoid any application of glue in the ear canals.
Mineral Oils:
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It is used to remove the insects in the inner ear canal.
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Mineral oil can be used to kill and remove insects from the ears.
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This method is avoided in cases of perforated eardrums.
What Are the Complications Associated With the Presence of Foreign Bodies in the Ears?
Some of the complications are as follows:
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External ear canal lacerations can occur in attempts to remove them.
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Perforation of the eardrum.
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Hearing loss.
What Precautions Should Be Taken if a Foreign Object Is Stuck in the Ear?
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Do not attempt to remove it with cotton-tipped applicators, as there is a risk of further pushing the object deep into the ears.
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Inform any family member and try to retrieve it with the help of tweezers if the object is visible.
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Turn the head to the affected side to remove the object.
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If any bleeding is present, cover the ear with a sterile dressing.
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If the patient cannot recover the object, notify the doctor immediately.
How to Prevent the Risk of Foreign Objects in the Ear?
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Keep smaller objects like small batteries, toys, and food items away from the children.
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Be around children under three years of age while playing.
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Choose larger toys and toys that cannot be dismantled for small children.
Conclusion
Foreign body entrapment in the ear is commonly seen in children. Safe and effective removal of the foreign body from the ears needs expertise and specialized equipment. The type, location, size, and patient cooperation are some factors on which the procedure of foreign body removal is decided. Any symptoms like bleeding from the ears, ear swelling, or hearing loss should be reported to the doctor immediately for a prompt diagnosis and management to prevent any further complications.
