Ver el código de «Ear foreign body»

==Background==
[[File:Gray907.png|thumb|Ear anatomy]]
*Usually children 6 years old or younger

{{FB types}}

==Clinical Features==
*Caregiver often reports seeing child put something in the ear
*[[hearing loss|Decreased hearing]] or [[earache|otalgia]]
*More common on right (hand dominant) side
*May have otorrhea or bleeding
*Foreign body contacting tympanic membrane can cause intractable [[Hiccups|hiccups]]

==Differential Diagnosis==
{{Ear DDX}}

==Evaluation==
*Typically seen on visual inspection or otoscopy
*Check other ear / nares

==Management==
*Button battery - Requires emergent removal (in consultation with ENT)
*Insect - Kill with mineral oil, [[EtOH]], diluted hydrogen peroxide, or 2% [[lidocaine]] prior to removal
**In an in-vitro trial mineral oil was faster and more effective than other methods to kill cockroaches<ref>Leffler, S., Cheney, P., & Tandberg, D. (1993). Chemical immobilization and killing of intra-aural roaches: an in vitro comparative study. Annals of emergency medicine, 22(12), 1795–1798. https://doi.org/10.1016/s0196-0644(05)80402-0</ref>
*[[Tympanic membrane rupture|Penetrating FB's]] - Have a low threshold for ENT consult

===Removal===
*Irrigation
**Contraindicated if suspected TM perforation, tympanostomy tubes, button battery, or vegetable parts (swells)
**Body temperature sterile water or normal saline to avoid inducing nystagmus
**Attach 14 or 16 ga IV catheter to 20-60 mL syringe
**Can also utilize an infant nasogastric tube instead of an IV catheter, place tip of catheter next to TM, connect syringe and irrigate
*Alligator forceps
*Right angle tool / day hook
*Scoop with curette (lighted curette helpful)
*Schuknecht extractor (attaches to wall suction)
*Dermabond on a swab stick<ref>Pride H, Schwab R. A new technique for removing foreign bodies of the external auditory canal. Pediatr Emerg Care. 1989;5(2):135-136. doi:10.1097/00006565-198906000-00017</ref>
**Allow glue to become tacky before inserting into canal
**May use disposable ear speculum to shield canal so do not accidentally glue stick to ear canal

===Antibiotics===
*[[Ofloxacin]] or [[ciprofloxacin]] + [[dexamethasone]] if perforated TM or significant trauma to ear canal

==Disposition==
*Emergent ENT for all button batteries failing ED management
*Urgent ENT consult/follow-up for TM injuries, retained FB, retained insect parts

==See Also==
*[[Foreign bodies]]
*[[Ear diagnoses]]

==External Links==
*[https://www.aliem.com/pem-search-rescue-ear-foreign-bodies/ ALiEM: PEM Pearls: Search & Rescue of Ear Foreign Bodies – Picking the Right Tool]

==References==
<references/>

[[Category:ENT]]
[[Category:Symptoms]]