Pediatric external auditory canal foreign bodies: a review of 698 cases

Management of Foreign Bodies in the Ear Canal

Using the appropriate instruments and techniques for removing a foreign body from the external auditory canal facilitates the procedure and reduces the risk of complications. Most ear foreign bodies can be addressed on a nonurgent basis, but batteries and caustic materials warrant prompt removal. Referral to an otolaryngologist should be considered for difficult cases or after a failed attempt.

Managing the Destructive Foreign Body: Water Beads in the Ear (A Case Series) and Literature Review

OBJECTIVE

To characterize our experience with super-absorbent polymer beads placed in the external auditory canal to better understand the damage caused and subsequent management required.

METHODS

Retrospective chart review of pediatric patients at 2 separate tertiary referral centers.

RESULTS

Seven patients were identified as having placed super-absorbent polymer beads in the external auditory canal, 6 of whom required removal under general anesthesia. Three patients did not suffer otologic trauma or hearing loss (average foreign body duration <72 hours). Four patients experienced severe otologic complications (average foreign body duration >1 week), all of whom were treated with otologic drops prior to bead identification. Of this severe complication group, 3 patients had restored hearing after surgical intervention, while 1 patient suffered profound hearing loss secondary to labyrinthitis ossificans.

CONCLUSION

Early recognition of otologic foreign bodies is important, particularly if expansile water-bead is suspected. Depending on timeframe, water beads are highly destructive to the middle ear structures, and most patients will require surgical intervention.

Comparison of Care Settings for Pediatric External Auditory Canal Foreign Bodies: A Meta-Analysis

OBJECTIVE

To compare the success and complication rates of pediatric external auditory canal foreign body (EAC FB) removal between Emergency Departments (ED), Primary Care Providers (PCP), and Otolaryngologists (ENT).

METHODS

PubMed, Scopus, and Embase were searched through January 13, 2022. Studies mentioning EAC FB removal success rates and types of healthcare settings were included. Pooled measures included abrasions/lacerations, TM perforations, and success rate stratified by healthcare setting.

RESULTS

Thirteen studies and 3891 patients were included in the meta-analysis. Most comparisons between EAC FB removal success rates for EDs versus PCPs versus ENTs were statistically significant. The highest FB removal success rate was in patients who presented to ENTs without previous removal attempts (92.9% [95% CI 84.6-98.2]). EDs had the lowest success rates (64.0% [95% CI 48.3-78.3]). For patients that had a previous attempt at FB removal, ENTs had a success rate of 64.1% [95% CI 42.0-83.5].

CONCLUSIONS

For ENTs treating pediatric EAC FB, removal success rates decrease if a different healthcare provider previously attempted EAC FB removal. This effect likely is due to decreased patient cooperativeness or increased FB complications (eg, canal edema and bleeding limiting visualization) after previous removal attempts. Individual institutions should identify conditions that increase EAC FB removal failure rates and necessitate ENT referral. Therefore, the communication and concerted efforts between EDs, PCPs, and ENTs are critical for the improved outcomes of pediatric EAC FBs.

Foreign Bodies in Ear: A Descriptive Study

Foreign bodies (FB) in the external auditory canal are relative medical emergency. The objective of this study was to describe the types of FB and their complications. Hospital-based descriptive study. This study is done at sub-district hospital Nasirabad (district Ajmer) from period 1 January2016 to 31 May 2020 for period of 3 years 5 months included all patients with foreign body ear. A total of 126 patients were included. All cases were attended by ENT specialist. In our study we concluded that most common incidence is children less than 5 years (63.49%), male:female ratio of 1.33:1, most of the patients present within 24 h of presentation, in maximum cases there is no complications, maximum the foreign body is present in right ear. All cases were attended by ENT specialist. Maximum cases are done in local anaesthesia or no anaesthesia at all, 4 case in light anesthesia and 3 cases referred to nearby higher centre. In this we concluded that foreign body is usually present in less than 5 years of age group. Proper instrumentation and proper skill is required to remove foreign body without any complications.

Removal of external auditory canal foreign bodies in the pediatric emergency department - A retrospective comparison study

INTRODUCTION

The removal of foreign bodies from the external auditory canal (EAC) is a common cause of referral to the pediatric emergency department (PED). The attempt at removal of foreign bodies can lead to complications ranging from mild canal injuries and through severe inner ear damage. The removal requires knowledge and expertise. Ear, Nose and Throat (ENT) physicians are considered the most qualified to remove these foreign bodies. The decision of when the ENTs need to be involved is debated.

METHODS

A retrospective analytical comparison study was conducted. The study included all children admitted to the PED for EAC foreign body removal, between the years 2009-2019.

RESULTS

A total of 333 children were included in the study. The mean age was 6.53 years. Success rate of the procedure on the first attempt performed by pediatricians was 82.4% and when performed by ENT physicians the success rate was 96.1%. However, when those with a previous attempt of removal were removed from the study the success rates of PED physicians were 93.9% and of ENT physicians were 96.8%.

CONCLUSION

This single center study shows that with correct case evaluation, the PED physician can and should succeed in EAC FB removal with minimal complications and comparable to ENT performance. If a first attempt failed, an ENT consult is warranted.

Epidemiological trends and outcomes of children with aural foreign bodies in Singapore

INTRODUCTION

Aural foreign bodies (FBs) are a common presenting complaint in emergency departments (EDs) worldwide. This study aims to describe trends and outcomes of aural FBs in the paediatric population, presenting to a tertiary hospital in Singapore.

METHODS

A retrospective review of medical records was conducted of all children 0-16 years old with aural FBs who presented to KK Women's and Children's Hospital ED from 2013 to 2017. Clinical data that were collected include patient demographics, type of FB, ear compartment and laterality of FB, symptoms, duration of impaction, mode of removal, outcome in ED, and final disposition.

RESULTS

There were a total of 1,003 cases. The largest age group consisted of 53.7% preschool children of 0-6 years. Males (61.7%) were more common than females (38.3%). FBs were predominantly organic materials (25.6%), followed by beads and stones (15.2%). Most FBs were found in the right ear (56.6%). The majority of patients were asymptomatic (62%). Symptoms observed included ear pain (20.1%), itch (4.8%) and bleeding (3.2%). FBs were removed by instruments (36.6%), suctioning (15.4%), syringing (8.2%), or a combination of methods (13.7%). In the ED, 73.9% of patients had an attempt at removal, among which 78.4% of FBs were successfully removed, 5.9% required specialist review, and 15.7% were unsuccessful.

CONCLUSION

The majority of paediatric aural FBs can be successfully removed in the ED. Emergency physicians should be trained and equipped with the relevant skills to remove aural FBs.

Imaging the External Ear: Practical Approach to Normal and Pathologic Conditions

The external ear (EE) is an osseous-cartilaginous structure that extends from the auricle to the tympanic membrane. It is divided into two parts: the auricle (or pinna) and the external auditory canal (EAC). Given the ease of access to the EE, imaging studies are not always needed to make a diagnosis. However, when lesions block visual access to areas deep to the EE abnormality, complications are suspected, or there is lack of response to treatment, imaging becomes essential. A basic understanding of the embryologic development and knowledge of the anatomy of the auricle and EAC are useful for accurate diagnosis of EE lesions. Congenital, traumatic, inflammatory, neoplastic, and vascular conditions can affect the EE. An overview of the anatomy and embryologic development of the EE is presented, with discussion and illustrations of common and uncommon conditions that affect EE structures and a focus on the CT and MRI features that are of interest to radiologists. CT is usually the first diagnostic modality used to evaluate the EAC and is the superior method for demonstrating bone changes. MRI provides excellent tissue characterization and enables one to better define lesion extension and perineural tumor spread. In addition, a flowchart to facilitate the differential diagnosis of EE abnormalities is provided. Online supplemental material is available for this article. ^©RSNA, 2022.

Satisfaction with an In-House Nasal Foreign Body Removal Manikin: A Randomized Controlled Trial

Introduction

Nasal foreign bodies can lead to life-threatening conditions. Hence, it is a necessity that physicians be well trained in the appropriate procedures for removal of nasal foreign bodies. However, training on real patients is not only unpractical it is also too dangerous, due to risk of foreign body aspiration during the procedure. Therefore, our goal was to construct a manikin, with a specific design, to serve all possible needs for training.

Methods

We developed an in-house manikin from 2 materials; these being flexible polyurethane foam and silicone. Silicone, which has elasticity similar to nasal alae, was used to develop the detachable nose and nasal cavity, whilst polyurethane foam, which is light and easy to carry, was used to develop the head. The in-house manikin was compared with a commercial manikin for satisfaction after a nasal foreign body removal procedure was performed in both groups, by 37 physicians, after conducting a randomized controlled trial with a crossover design.

Results

The satisfaction scores of the in-house manikin were statistically significantly higher than the satisfaction scores of the commercial manikin for 6 dimensions: proper size, ease of use, ease of maintenance, flexibility of nasal alae relative to actual anatomy, similarity of the nasal cavity relative to actual anatomy and confidence that the manikin can upskill the medical students ability to practice on real patients (p value < 0.05).

Conclusion

This in-house nasal foreign body removal manikin design had high satisfaction for training and could be used to develop further nasal foreign body removal manikins in the future.

Intriguing aural foreign body and algorithm of management of foreign body

Foreign body (FB) in the external auditory canal is more common among the paediatric age group compared with adult patients and it may be deposited in various ways. An accidental animate aural FB is reported to be commonly encountered in adults whereas inanimate FBs are likely to be found among adult patients with learning disability. An elderly man presented with accidental penetration of rattan tree stem into his ear while gardening. Removal of a FB from the external auditory canal requires expertise as deep penetration of a FB into the middle and inner ear may lead grave complications, especially when overzealous removal is attempted by nonear, nose and throat (ENT) personnel. This case emphasises on the importance of awareness of meticulous removal of a FB under proper visualisation so as to avoid unnecessary complications. Additionally, we propose an algorithm for proper removal of aural FB in an acute care setting.

A change in clinical practice for aural foreign bodies - what we learnt from the coronavirus disease 2019 pandemic

Objective

This case series, conducted during the coronavirus disease 2019 pandemic, investigates the impact of leaving aural foreign bodies in situ for a prolonged period of time, including the risk of complications and success rates of subsequent removal attempts.

Method

A retrospective study of aural foreign body referrals over a six-month period was carried out.

Results

Thirty-four patients with 35 foreign bodies were identified (6 organic and 29 inorganic). The duration of foreign bodies left in situ ranged from 1 to 78 days. Four patients suffered from traumatic removal upon initial attempts. First attempts made by non-ENT specialists (68.8 per cent) all failed and were associated with a high risk of trauma (36.4 per cent).

Conclusion

Because of the coronavirus disease 2019 pandemic, this is the first case series to specifically investigate the relationship between the duration of aural foreign bodies left in situ and the risk of complications. Our data suggest that prolonged duration does not increase the incidence of complications.

The outcome and complication of endoscopic removal of pediatric ear foreign body

OBJECTIVE

To evaluate the outcome and complications of endoscopic removal of pediatric ear foreign bodies (FBs).

METHODS

This study was a retrospective chart review of pediatric and adult patients who presented for ear FB removal over a 5-year period.

RESULTS

In 191 children with ear FBs, 105 (55.0%) of the FBs were in contact with or close to the tympanic membrane (TM). The FB was removed using direct suction with a sucker in 172 (90.1%), a right-angle hook alone in 13 (6.8%), and alligator forceps alone in 6 (3.1%). In total, 34 (17.8%, 34/191) complications were reported; they included complications from the FB itself in 2 (5.9%), from prior attempts at removal by non-specialist otologists in 29 (85.3%), and from attempts by the authors in 3 (8.8%). The complication rate for non-specialist otologists using headlights was significantly higher than that for specialist otologists using endoscopes (29/82, 35.4% vs 3/109, 2.8%, P < 0.001).

CONCLUSIONS

Most pediatric ear FBs are small and in contact with the TM. The use of an endoscope to assist with foreign body removal may be both safe and effective for pediatric ear FBs.

Extraction of Aural Foreign Bodies in a Rural Setting: 10-Year Review and a Novel Method to Remove Magnetic Stones

BACKGROUND

The external auditory canal's unique anatomical characteristics made the presence of foreign bodies (FBs) a clinical challenge, particularly in rural settings without ready access to tertiary care and specialist intervention.

AIMS

Our study surveys the experience in aural FBs surgical management in a rural Australian tertiary center. It proposes a safe, easy, and affordable technique to remove stones from the ear canal.

METHODS

We have completed a 10-year retrospective surgical chart review, including 474 patients (52 adults and 428 children) requiring surgical management to remove aural FBs at the Royal Darwin Hospital, Northern Territory, Australia. We surveyed for patient demographics, foreign-body description, complications, location, and removal attempts. We identified what factors determine the need for surgical management and propose a technique for a safe, uncomplicated, and affordable removal of stones from the ear canal after applying this method in a small subgroup.

RESULTS

The most common FBs requiring surgery in children were stones. A predominance in the Aboriginal population from remote communities was found, leading to a nasal bridle magnet technique to remove stones in rural settings. This method reduces the number of extraction attempts of the most frequent FB found in children's ears, aiming to minimize complications, negative experiences, and health cost.

CONCLUSION

Contrary to international literature, stones were found to be the most common FB in remote aboriginal populations. The proposed technique reduces the number of extraction attempts of the most frequent FB found in children's ears, aiming to minimize complications, negative experiences, and health cost.

Skull base osteomyelitis with secondary cavernous sinus thrombosis: a rare presentation of an animate foreign body in the ear

A 42-year-old woman presented with fever, left ear pain, restricted mouth opening, difficulty in swallowing and inability to open her left eyelid for a period of 10 days. She was treated with antibiotics for the same at a local medical facility; however, a sudden decrease in her left eye vision prompted her to visit our tertiary centre. Her history was insignificant except for having multiple left ear syringing for an insect removal 10 days before onset of her current symptoms. On examination, she had ptosis of the left eye with chemosis, dilated pupil with only perception of light and restricted ocular mobility. Oral examination revealed trismus and bulge in the left peritonsillar region. Left ear examination revealed a large central perforation with mucopurulent discharge. CT of the neck with contrast demonstrated a collection in the left peritonsillar space with left internal carotid artery thrombosis. MRI of the brain with gadolinium revealed left cavernous sinus thrombosis with acute infarcts in the left frontal lobe. An emergency incision and drainage of the left peritonsillar abscess was performed. Culture grew broad aseptate fungal hyphae. Despite starting on antifungal therapy, she succumbed to her illness.

Pediatric foreign bodies of the ear: A 10-year national analysis

OBJECTIVES

To estimate the incidence of emergency department visits for pediatric ear foreign bodies. To identify the most common items and their trends.

METHODS

The Nationwide Electronic Injury Surveillance System (NEISS) was queried for emergency department visits involving the diagnosis of foreign bodies in the ear including pinna and canal in children over the most recent 10-year span available. National incidence estimates and demographic data were extracted from the same database.

RESULTS

Ear foreign bodies in children made up an estimated total 446,819 ED visits nationwide over the past 10 years. The mean age was 7.2 ± 4.3 years old. The majority (55.6%, n = 248,531) of cases were female. The most common class of objects found was jewelry, primarily embedded earrings and beads, accounting for 55.5% visits, followed by paper products at 7.1%, pens and pencils at 4.1%, desk supplies (erasers) at 3.7%, BBs or pellets at 3.5%, and earplugs and earphones at 3%. Females were significantly more likely to have jewelry foreign bodies, and males were significantly more likely to have foreign bodies from all other categories other than first-aid supplies.

CONCLUSION

Foreign bodies of the ear are a common reason for emergency department visits in children, primarily jewelry, paper products, and desk supplies. Recognition of commonly encountered objects can aid in both speedier recognition of unknown objects, as well as guide patient counseling.

Pediatric Aural Foreign Body Extraction: Comparison of Efficacies Among Clinical Settings and Retrieval Methods

OBJECTIVES

To compare the efficacy of aural foreign body (FB) extractions among medical care settings and determine if certain methods of extraction resulted in higher failure rates and procedural complications.

STUDY DESIGN

Case series with chart review.

SETTING

Emergency departments (EDs), urgent cares (UCs), pediatric primary care providers (PCPs), and otolaryngologists (ENTs).

METHODS

A total of 366 pediatric patients with EAC foreign bodies at a tertiary children's hospital and associated satellite clinics.

RESULTS

The ED/UCs (17.46%), PCPs (75.22%), and ENTs (94.54%) exhibited highly variable success rates for pediatric aural FB extractions. Complications were considerably higher for attempts by ED/UCs (22.22%) as compared with PCPs (2.61%) and those of unclear etiology (2.73% of all attempts). Use of balloon-tipped catheters and adhesive-tipped probes (eg, cyanoacrylate/superglue) for FB extraction exhibited 0% success rates with high severity of complications.

CONCLUSION

Our statistics provide an example in which ED/UCs had higher failure rates at pediatric aural FB removals when compared with PCPs and ENTs. If a single provider (PCP or ED/UC) fails to retrieve an aural FB or if the provider is not comfortable conducting the procedure, then referral to an ENT is preferable to another PCP or ED/UC. Our evidence reveals that balloon-tipped catheters and adhesive-tipped probes for FB removal in the pediatric population are prone to failure and higher rates/severity of complications.

The aural foreign body space: A review of pediatric ear foreign bodies and a management paradigm

PURPOSE

We aim to describe and review the management of pediatric aural foreign bodies (FBs).

METHODS

We performed an observational study and retrospective chart review with statistical analysis of management for patients presenting with aural FBs to the Emergency Department (ED) with or without ENT consultation, or presenting directly to the ENT clinic.

RESULTS

There were 166 objects in the ears of 155 children. Paper and beads were the most common objects. Micro-alligator forceps and small right-angle hooks were the most commonly used instruments for removal. 60% of patients had attempted removal prior to referral to Otolaryngology, who removed 72% of the FBs in the outpatient setting, 23% in the operating room, and 2.5% in the ED.

CONCLUSION

Taking into account certain characteristics of the object reflects an efficient manner in which to determine referral of difficult removals to Otolaryngology. Providers should determine if the FB is very hard or very soft and spherical or cylindrical with secondary consideration of cost to the patient and hospital in order to properly navigate treatment. Soft and irregular objects may be extracted without need for referral to Otolaryngology. Patients with aural FBs that are hard or round, in instances which previous attempts have failed, and/or where there is trauma to the ear should be referred to Otolaryngology to avoid worsening the position of the FB and increasing the chances of requiring removal in the operating room.

Eustachian Tube Foreign Body with Endoscopic-Assisted Surgical Removal

Objectives. Foreign bodies of the external and middle ear are not uncommon; however, foreign bodies in the eustachian tube are rare. Here we describe the presentation, imaging, and endoscopic-assisted surgical management of a case of eustachian tube foreign body. Methods. A 34-year-old male was seen for evaluation of foreign body of the left eustachian tube while working with metal at a machine shop. Imaging and surgical management are highlighted and review of available literature regarding foreign bodies of the eustachian tube is presented. Results. A CT scan revealed a foreign body present approximately 1 cm into the bony eustachian tube. The patient underwent middle ear exploration which required endoscopic assistance to adequately visualize the foreign body. The foreign body was unable to be removed and required the creation of a bony tunnel lateral to the eustachian tube for visualization and access to the foreign body. Conclusions. This report presents a rare case of eustachian tube foreign body. Use of the endoscope during the surgical removal greatly enhanced the ease and safety of removal. This report also highlights the importance of ear protection with any machining and welding work.

Clinical Characteristics of External Auditory Canal Foreign Bodies in Children and Adolescents

OBJECTIVES

Foreign bodies (FBs) in external auditory canal (EAC) can occur at any age but are especially common in children and adolescents. The aims of the study were to evaluate the clinical characteristics of EAC FBs in children and adolescents and to discuss their proper management.

METHODS

A retrospective medical chart review was performed on patients who were treated for EAC FBs in a tertiary referral center from January 2007 to December 2017. We investigated the parameters of age, sex, type of FB, sedation method, complications, and removal strategy.

RESULTS

Of 284 patients, 176 (62.0%) were male. Peak incidences were noted at the ages of 3 to 6 years and 17 to 18 years. The frequently observed FBs were insects, followed by air-gun pellets, cotton balls, marbles, and earrings. Forty-one (14.4%) EAC FBs were removed with the naked eye, while 243 (85.6%) were removed under microscope in the otolaryngology department. Of these patients, 23 (9.5%) were administered sedatives and 1 (4.1%) needed general anesthesia. During or after the removal procedure, 4 (15.5%) patients had complications of EAC abrasion or laceration (42, 14.8%), and tympanic membrane perforation (2, 0.7%).

CONCLUSIONS

External auditory canal FB showed a distinct characteristic of incidence regarding age, related to removal strategies. Characteristics of FB must be considered for safe removal.

Aural and nasal foreign bodies in children - Epidemiology and correlation with hyperkinetic disorders, developmental disorders and congenital malformations

OBJECTIVES

Foreign body incorporation in children is often a serious situation. Attention deficit hyperactivity disorder (ADHD) could be a risk factor for self-insertion of foreign bodies. Large cohort analyses are missing.

METHODS

This was a retrospective analysis of patients' records from a health insurance company representing 2.19% of the German population and 1.75% of German children and adolescents. According to the International Classification of Diseases, children in the age range between 1 and 18 years have been screened for foreign bodies in ear, nasal sinus and nostrils as well as for hyperkinetic disorders (F90), disorders of psychological development (F80-F89), and congenital malformations, deformations and chromosomal abnormalities (Q00-Q99).

RESULTS

In total, 12887 children (6609 male; 6278 female) have been treated in 16929 cases. The majority (n = 10041 (77.9%)) presented with foreign body incorporation on a single occasion. On average, 1.31 cases of foreign body treatment were recorded per child; 14.1% of children with foreign body treatment (FBT) also had a record of hyperkinetic disorder, 52.7% had a disorder of psychological development, and 50.8% a congenital malformation. Mean occurrence of FBT was 174.8 days before the diagnosis of a hyperkinetic disorder but 517.2 days after the diagnosis of a psychological development disorder and 683.1 days after the diagnosis of a congenital malformation, deformation or chromosomal abnormality.

CONCLUSION

Patients with disorders of psychological development as well as children with congenital malformations are high-risk patients for nasal and aural foreign bodies. The prevalence of a hyperkinetic disorder in patients with FBT is much higher than in the normal population. ADHD is a risk factor for foreign bodies.

Cost comparison and safety of emergency department conscious sedation for the removal of ear foreign bodies

OBJECTIVES

The purpose of this study is to investigate the relative cost and safety of ear foreign body (FB) removal via conscious sedation in the emergency department.

METHODS

A retrospective review of patients presenting from 2000 to 2015 to the emergency department at Mayo Clinic, Rochester, Minnesota was performed. 63 patients requiring sedation for ear foreign body removal were identified. Descriptive data, safety data, and costs were obtained for the study.

RESULTS

There were no appreciable differences in patient safety outcomes and otologic outcomes in patients who received sedation in the emergency department or anesthesia in the operating room for FB removal. Cost analysis demonstrated increased cost associated with operating room utilization verses conscious sedation in the emergency department, with the greatest cost increase being in patients evaluated first in the emergency department and then sent to the operating room.

CONCLUSIONS

Ear foreign body removal in the emergency department is shows a similar safety profile to removal in the operating room, but at a markedly lower cost. Emergency department conscious sedation should be considered a viable option in appropriately selected patients with this common problem given these results.

External Auditory Canal Foreign Body Extraction Outcomes

OBJECTIVES

To compare pediatric external auditory canal (EAC) foreign body extraction outcomes by clinical setting and identify factors predictive of successful removal.

METHODS

Retrospective review of pediatric patients with EAC foreign bodies to a single institution emergency department (ED) and otolaryngology clinic (OTO) between January 2010 and April 2015. Patient characteristics, foreign body type, removal attempts, instrumentation utilized, and complications were evaluated with respect to clinical setting and patient outcome.

RESULTS

In all, 1197 patients with EAC foreign bodies were identified, 759 (63%) of whom presented primarily to the ED. Successful removal was achieved in OTO in 92.9% of cases and the ED in 67.9% of cases. Beads and spherical objects had the overall lowest rates of successful removal. Likelihood of removal decreased significantly after one unsuccessful attempt. Complications were reported in 35.7% of patients undergoing removal in the ED and 5.0% of patients undergoing removal in the otolaryngology clinic.

CONCLUSIONS

Patients commonly present to the ED for removal of EAC foreign bodies. Referral to an otolaryngologist is recommended if the object is spherical or after one unsuccessful attempt at removal.

Is Radiologic Evaluation Necessary to Find out Foreign Bodies in Nasal Cavity?

Although there were previous studies on the clinical aspects such as etiology, treatment modalities, studies regarding the necessity of radiologic evaluation for nasal foreign body were limited. The aim of this study is to evaluate the necessity and indication of radiologic evaluation for nasal foreign bodies. There are consecutive patients aged less than 10 years who presented with suspected foreign bodies in nasal cavity. We reviewed the patient's age and sex, including the methods of evaluation, management tools, and types of foreign bodies. There were 35 cases (11.4%) on whom radiographs were performed in the 24 uncooperative patients and 11 cooperative patients who were not identified with any foreign bodies via nasal endoscopy. Among them, only 4 cases had positive reports of foreign body and the others were normal radiologic findings. We suggest that the radiologic evaluation is always not necessary to find the location of nasal foreign bodies. It, however, should be performed in cases of negative findings of physical examination with anterior rhinoscopy or sinus endoscopy and unwitnessed foreign bodies to rule out metallic contents, especially button type battery.

Presentation and management of nasal foreign bodies at a tertiary children's hospital in an American metro area

OBJECTIVES

To examine rates of otolaryngology intervention in children presenting to our emergency department with nasal foreign bodies, factors associated with otolaryngology involvement, rates of complications, and details on nasal button battery exposure.

METHODS

All patients presenting with a nasal foreign body to Children's Hospital Colorado from 2007 to 2012 were identified. Factors leading to referral to otolaryngology and operative intervention were examined, as well as complications.

RESULTS

102 patients were included. 36 (35%) patients were referred to the otolaryngology clinic, of which 58.9% required operating room intervention. 66 (64.7%) children had their nasal foreign bodies removed in the emergency room, however 30 (45%) of these were removed by an otolaryngology resident or attending physician. Overall, 64.7% of nasal foreign bodies required removal by otolaryngology. Of the 15 objects removed in the operating room, six were button batteries. No septal perforations occurred as a result of nasal button battery exposure. Multivariable logistic regression showed two significant predictors of OR removal: age and disc shaped objects.

CONCLUSION

While emergency department providers are comfortable attempting removal of nasal foreign bodies, there was a high rate of otolaryngology intervention. Based on this data, there is a need to educate emergency room providers on nasal anatomy and techniques for nasal foreign body removal.

Hazardous complications of animate foreign bodies in otology practice

BACKGROUND

Animate foreign bodies in the ear are frequent occurrences in otology practice. Such foreign bodies may lead to hazardous complications.

METHOD

This paper describes a retrospective study of six patients with a recent history of an insect in the ear who presented with various complications following intervention received elsewhere.

RESULTS

An insect was retrieved from the external auditory canal in four cases and from the antrum in two cases. The patients presented with progressive otological complications: two patients who presented with orbital apex syndrome and cavernous sinus thrombosis succumbed to the disease; three patients suffered sensorineural hearing loss; and two patients had persistent facial palsy. One patient with sigmoid sinus thrombosis, who presented early, experienced complete recovery.

CONCLUSION

Insects in the ear can lead to hazardous complications. Animate foreign bodies should preferably be managed by a trained otologist, even in an emergency setting. Patients with delayed presentation and complications have a guarded prognosis.

Actualities of management of aural, nasal, and throat foreign bodies

BACKGROUND

Foreign bodies (Fbs) in the ear, nose, and throat (ENT) are common presentations in healthcare settings worldwide.

AIM

This study was carried out to review the modes of presentation, management, and outcome of inserted Fbs in our setting.

SUBJECTS AND METHODS

A 5-year retrospective study of cases of ENT Fbs managed at two referral hospitals in Abuja Nigeria. The analysis was done with Chi-square and Pearson correlation.

RESULTS

Five hundred and ninety-four patients aged 0-75 years, M:F = 1.1 (295 vs. 299) were reviewed. Prevalence was predominantly among the under 5 s; 286/594 (P = 0.001). ENT Fbs were 356/594 (59.9%), 167/594 (28.1%) and 71/59 (12.0%), respectively. Cotton wool 133/356 (37.4%) and beads 75/356 (21.1%) constituted most aural Fbs. Beads 45/167 (27.0%) and grains/seed 37/167 (22.1%) were the most common nasal Fbs while fish bones 38/71 (53.5%) and piece of metals 12/71 (16.9%) were dominant in the throat. Most cases of aural and nasal Fbs were asymptomatic. Ear syringing was the most common method for removal of aural Fbs 216/594 (60.7%) and instrumentation under direct vision for nasal Fbs 153/167 (91.6%). Furthermore, 52/71 (73.2%) of throat Fbs were removed under general anesthesia. ENT complications observed included bruises, lacerations, perforations, Epistaxis, and a case of respiratory failure. Delayed presentation (beyond 24 h) was seen in 489/594 (82.3%) of cases while failed previous attempts by untrained hands constituted 353/594 (59.4%). A strong correlation between complications and duration of Fbs insertion (R (2) = 0.8759) was established.

CONCLUSIONS

Fbs in ENT are common especially among children below 5 years. Majority presented beyond 24 h, and there was a strong correlation between duration of Fbs insertion and associated complications. Repeated failed attempts and delayed referrals to otorhinolaryngologists from peripheral centers were also contributing factors to increased morbidity and hence the need for awareness.

Aural foreign body extraction in children: a double-edged sword

Introduction

Foreign body insertion into the ear in children is common world-wide. The goal of this work is to describe the procedural complications of aural foreign body extraction in children.

Methods

A retrospective analysis of records of children with aural foreign bodies was conducted. Patients’ bio data, type of foreign bodies, referrals, techniques of removal and complications were extracted from the case files. The foreign bodies were categorized into graspable and non-graspable objects. Patients with complications caused directly by the foreign body were excluded.

Results

There were 136 cases. Eighty-seven (64.0%) were males while forty-nine (36.0%) were females. Their age range from 5 days to 16 years with 109 (80.2%) aged below 8 years. Eighty-nine (65.4%) and 47 (34.6%) cases were treated by otolaryngologists and non-otolaryngologists with a complication rate of 15.7% and 68.1% respectively. One case suffered severe hearing loss following complicated attempt at removing foreign body in the only hearing ear. Overall, the complication rate was higher (44.4%) with removal of non-graspable than (28.6%) with graspable objects.

Conclusion

Procedural complication is an ever-present hazard of aural foreign body extraction in children. Its occurrence can be prevented or largely reduced if health care-givers know their limitation based on their clinical skills and acquaint themselves with established criteria for referral. As a rule, we suggest that, foreign body in the only hearing ear and failed attempted first removal should be considered criteria for otolaryngologic referral.

Foreign body resulting in chronic otomastoiditis and facial palsy

We present a case of a foreign body in the ear of 5-year-old girl child. She presented with features of chronic suppurative otitis media with facial nerve palsy. On exploration exuberant granulation was found in attic and middle ear. A foreign body (seed) was found buried within the granulation tissue which was removed. Bony facial canal was dehiscent in the tympanic segment. She had recovery of facial nerve function. The case is being reported to increase awareness among otolaryngologist and to consider foreign body as a differential diagnosis in cases of complicated CSOM; especially in children.

ENT foreign bodies: profile of the cases seen at a tertiary hospital emergency care unit

Individuals often seek help with foreign bodies (FB) in their ears, noses, and throats. Proper recognition, study, and management of foreign bodies is required to prevent complications.

Objective

To analyze the profile of the patients seen for FB at a reference otorhinolaryngology emergency care unit between February of 2010 and January of 2011.

Method

Cross-sectional retrospective historical cohort study based on digitized patient charts.

Results

FB accounted for 827 cases and 5.3% of all patients seen in the ENT emergency unit. Children were affected more frequently, particularly when aged 8 and under. No statistically significant differences were seen between genders. Foreign bodies were mostly located in the ears (64.4%), followed by the nasal fossae (19.5%), and the oropharynx (8.9%). Complications were seen in 4.5% of the cases, and 4.4% required general anesthesia to have the FB removed.

Conclusion

In our ENT practice, foreign bodies were more commonly seen in children; the ears were the preferential site of occurrence. Complication rates and use of general anesthesia were low in our practice. It should be stressed that ENT foreign bodies need to be properly managed so as to avoid complications.

Aural foreign bodies: descriptive study of 224 patients in Al-fallujah general hospital, iraq

Foreign bodies (FB) in the external auditory canal are relative medical emergency. The objective of this study was to describe the types of FB and their complications and to highlight on new FB not seen before which was the bluetooth devices that were used for cheating during high school examination in Al-Fallujah city. This was a two-year hospital-based descriptive study performed in the Department of Ear, Nose and Throat (ENT), Al-Fallujah General Hospital, from June 2011 to May 2013; during this period, 224 FB had been extracted from 224 patients. Beads were extracted from 68 patients (30.4%), cotton tips were extracted from 50 patients (22.3%), seeds and garlic were extracted from 31 patients (13.8%), papers were extracted from 27 patients (12.1%), insects were extracted from 24 patients (10.7%), button batteries were extracted from 13 patients (5.8%), and bluetooth devices were extracted from 7 patients (3.1%). Most of the cases did not develop complications (87.5%) during extraction. The main complications were canal abrasion (4.5%). Proper instrumentation allows the uncomplicated removal of many FB. The use of general anesthesia is preferred in very young children. Bluetooth device objects should be considered as new aural FB, especially in our territory.

Critical ENT skills and procedures in the emergency department

Injuries and illness to the ears, nose, and throat are frequently seen in the emergency department. The emergency medicine physician must be proficient in recognizing these injuries and their associated complications and be able to provide appropriate management. This article discusses the most common otorrhinolaringologic procedures in which emergency physicians must be proficient for rapid intervention to preserve function and avoid complications. A description of each procedure is discussed, as well as the indications, contraindications, equipment, technique and potential complications.

Critical procedures in pediatric emergency medicine

Children comprise approximately one-quarter of all visits to most emergency departments. Children are generally healthier than adults, yet there are similar priorities in assessment and management of pediatric patients. The initial approach to airway, breathing, and circulation still applies and is first and foremost in the evaluation of young infants and children. There are certain anatomic, physiologic, developmental, and social considerations that are unique to this population and must be taken into account during their evaluation and treatment. In this review, we present and discuss an evidence-based approach to high-yield procedures necessary for all emergency physicians taking care of children.

Mastoiditis and meningitis complicating an aural foreign body

Children commonly present to emergency departments with foreign bodies in the ear. In addition, physicians place wicks in the ear canal as part of the treatment of otitis externa. Usually, these foreign bodies are easily removed, but occasionally, removal must be deferred or is delayed by parents. Therefore, the dangers of retained foreign bodies are important for the emergency physician to be aware of. We report the highly unusual case of a 12-year-old girl who presented with ear pain for 3 weeks. She was found to have an ear wick in place as part of the treatment of otalgia. She was subsequently diagnosed with mastoiditis and meningitis. This is first time mastoiditis and meningitis has been reported as a complication of ear wick placement, although not the only case of an intracranial complication of an aural foreign body.

Pediatric battery-related emergency department visits in the United States, 1990-2009

OBJECTIVE

To investigate the epidemiology of battery-related emergency department (ED) visits among children <18 years of age in the United States.

METHODS

Using a nationally representative sample from the National Electronic Injury Surveillance System, battery-related ED visits in the United States from 1990 to 2009 were analyzed. Four battery exposure routes for patients were determined from diagnosis codes and case narratives: ingestion, mouth exposure, ear canal insertion, and nasal cavity insertion.

RESULTS

An estimated 65788 (95% confidence interval: 54498-77078) patients <18 years of age presented to US EDs due to a battery-related exposure during the 20-year study period, averaging 3289 battery-related ED visits annually. The average annual battery-related ED visit rate was 4.6 visits per 100000 children. The number (P < .001) and rate (P = .002) of visits increased significantly during the study period, with substantial increases during the last 8 study years. The mean age was 3.9 years (95% confidence interval: 3.5-4.2), and 60.2% of patients were boys. Battery ingestion accounted for 76.6% of ED visits, followed by nasal cavity insertion (10.2%), mouth exposure (7.5%), and ear canal insertion (5.7%). Button batteries were implicated in 83.8% of patient visits caused by a known battery type. Most children (91.8%) were treated and released from the ED.

CONCLUSIONS

This study evaluated battery-related ED visits among US children using a nationally representative sample. Batteries pose an important hazard to children, especially those ≤ 5 years of age. The increasing number and rate of battery-related ED visits among children underscore the need for increased prevention efforts.

Non food foreign body injuries

RATIONALE AND AIM

The aim of the present study is to acquire a better understanding of Non Food Foreign Bodies (NFFB) injuries in children with particular regard to the quantification of the risk of complications and hospitalization associated with patient characteristics, FB features, FB location and circumstances of the accident, as emerging from the SUSY Safe Web-Registry.

METHODS

The present study uses data provided by the SUSY Safe Project, a DG SANCO co-funded project which was aimed to collect as many scientific data as possible regarding Foreign Bodies (FB) injuries in children aged 0-14 years and to serve as a basis for a knowledge-based consumer protection activity in the Europe market. FBs were characterized by size, shape and consistency. Descriptive statistics (absolute and relative number or median, I and III quartile according to the categorical or continuous variable, respectively) were calculated for each considered non food item characteristics; FB features distribution by children class age and site of obstruction were assessed. Two different outcomes were considered: hospitalization and complication. FBs which most frequently cause complications were identified. The association between children age, adult presence, object characteristics and outcomes was computed using crude odds ratios and the related 95% confidence intervals.

RESULTS

16,878 FB injuries in children aged 0-14 yrs have been recorded in the Susy Safe databases. FB type was specified in 10,564 cases; among them 7820 (74%) were due to a non food item. Almost two thirds of injuries occurred in patients 3 years or more old. 53% of patients were males, while 47% were females. When injury happened, the great part of children (86%) was playing. Almost 30% (2339) of injuries happened under adults' supervision. Complications occurred in 299 cases and the most documented was infections (10% of cases) followed by perforation (5%).

CONCLUSIONS

The inhalation/aspiration of a FB, as well as the ingestion and the insertion in the orifices of a FB may result in significant morbidity. Particularly, long-standing or hazardous foreign bodies can cause extensive damage. Some objects, because of their composition, contour, or location, are particularly hazardous: for instance, objects with sharp edges pose a significant risk of laceration and perforation, while fragments of toys have been found only in 2 cases. Parents are frequently unconscious of hazard related with some objects and they are not adequately able to promptly recognize dangerous objects and risky situations. Moreover, also clinicians seem to pay little attention to adult role in the dynamic of the accident: in fact in case series descriptions, data regarding adult presence are often under-reported. On the contrary, since many injuries to children cannot be prevented without some degree of active behavior on the part of parents, the dissemination of information regarding safe behaviors and the implementation of educational strategies aiming to improve parent's attention toward this issue could be fundamental in preventing injuries and need to be promoted by family pediatricians and health practitioners.

Food foreign body injuries

RATIONALE AND AIM

The purpose of this study is to acquire a better understanding of Food Foreign Bodies (FFB) injuries in children characterizing the risk of complications and prolonged hospitalization due to food items according to patients' characteristics, circumstances of the accident, Foreign Body (FB) features and FB location, as emerging from the SUSY Safe Web-Registry.

METHODS

The present study uses data provided by the SUSY Safe Project, a DG SANCO co-funded project started in February 2005, which was aimed at establishing an international registry of cases of Foreign Bodies (FB) injuries in children aged 0-14 years. The analysis was carried out on injuries due to a food item. FB location was reported according to ICD9-CM code: ears (ICD931), nose (ICD932), pharynx and larynx (ICD933) trachea, bronchi and lungs (ICD934), mouth, esophagus and stomach (ICD935). Age and gender injury distributions were assessed. Data regarding adult supervision and activity before injury were also evaluated. FBs which most frequently cause complications were identified. The association between children age, adult presence, object characteristics and hospitalization/complications was computed using unweighted odds ratios and the related 95% confidence intervals.

RESULTS

16,878 FB injuries occurred in children aged 0-14 years have been recorded in the SUSY Safe databases. FB type was specified in 10,564 cases; among them 2744 (26%) were due to a food item. FB site was recorded in 1344 cases: FB was located in the ears in 99 patients, while 1140 occurred in the upper and lower respiratory tract; finally, 105 food items were removed from mouth, esophagus and stomach. Complications occurred in 176 cases and the most documented was pulmonary or bronchial infections (23%) followed emphysema or atelectasis and by and asthma (7%). Bones were the commonest retrieved FFB encountered in this study, while nuts seem to be the FFB most frequently associated to complications.

CONCLUSIONS

On the basis of this study we make the strong recommendation that parents should be adequately educated and provide age-appropriate food to their children and be present in order to supervise them during eating especially during a critical period ranging from 2 to 3 years of age.

A child presenting with a bullet in the middle ear: case report

Introduction

Foreign bodies in the external auditory canal are common in both adults and children. Removal of the foreign body requires skill, but is usually successfully performed in the emergency department. We report a case of a child with a bullet in ear canal which was pushed into the middle ear during an attempt to remove it.

Case Presentation

A 6-year-old Thai boy went to the community hospital with his parents, who reported that their child had pushed a bullet into his ear. Otoscopic examination revealed a metallic foreign body in his external auditory canal. The first attempt to remove the foreign body failed and the child was referred to an otolaryngologist. We found that the tympanic membrane was ruptured, with granulation tissue in the middle ear and the bullet was located in the hypotympanum. The foreign body was removed via a post-auricular approach.

Conclusion

Removal of a foreign body from external auditory canal is an essential skill for physicians. Careful removal can prevent further trauma and complications. When the first attempt fails, referral to an otolaryngologist is recommended.

Study on clinical presentation of ear and nose foreign bodies

Ear and nose foreign bodies are common problems affecting the children but adults are not an exception. A prospective study involving 87 patients is undertaken concentrating on presentation of patients with various types of ear or nasal foreign bodies. In the present study common presenting complaints and uncommon presentation scenarios encountered by us like a nasal foreign body with intra cranial complications, an impacted middle ear foreign body with mastoiditis is discussed. The present article emphasizes the need of considering presence of foreign bodies even in the absence of appropriate clinical signs and symptoms suggestive of a foreign body in ear or nose.

Otitis media with effusion in children and its correlation with foreign body in the external auditory canal

Otitis Media with Effusion (OME) is difined as the chronic accumulation of mucus within the middle ear and sometimes the mastoid air cell system. Significant hearing loss may go unnoticed and may result in improper development of speech and language. Foreign bodies in the external auditory canal of paediatric patients are commonly encountered in day-to-day practice. The purpose was to see if there is any relation between foreign bodies in ears and otitis media with effusion. A prospective study of consecutive cases was conducted between August 2005 and August 2007 at a teaching hospital. All children presenting with the history of a foreign body in the external auditory canal were included in this study. 50/74 that is 67.8% of the children in the study group had abnormal findings in the tympanogram whereas only 28/74 that is 37.8% children from the control group had abnormal findings in tympanogram. This study indicates that significant eustachian tube dysfunction to frank OME, causes irritation and/or earache in children which may compel them to put things into the ear. So children with an external auditory foreign body must be followed up in an ENT clinic. This may be an early opportunity to diagnose an underlying undetected OME and/or eustachian tube dysfunction in children, preventing the development of any complication from the undetected OME.

Foreign bodies in ENT in a teaching hospital in Eastern India

OBJECTIVE

To evaluate the nature, common sites, modes of presentation of various foreign bodies (FB) in Ear, Nose and Throat (ENT).

MATERIALS AND METHODS

Observational retrospective study carried out at Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan. The study period was between Jan 2006 to Jan 2007. The information obtained from the hospital record books.

RESULTS

Four hundred and eighty-two patients presented in the Department of Otorhinolaryngology of Vivekananda Institute of Medical Sciences, in the study period with FB in their ENT. Out of 482 pts, the commonest location of FB was to be in throat with 302 pts (62%) followed by ear with 119 pts (25%) and nose 61 pts (13%). Amongst the FB in throat the commonest was fish bone and the commonest site being tonsils. Artificial denture accounted for a significant number of 13 (4.3%). External auditory canal was the commonest site of FB lodgment in ear found in 118 patients (99.16%). Nasal FB were found in 61 patients; more common in pediatric age group (98.36%).

CONCLUSION

From this study we have found that FB lodgement is a very common complaint with which patients come to otolaryngologist. The commonest site of FB lodgement is in the throat. Most of the FB could be removed in emergency room (ER) with or without Local Anesthesia.

Hydroscopic properties of organic objects that may present as aural foreign bodies

Background

Organic foreign bodies swell when irrigated with water, potentially making extraction more difficult. As the degree and rate of swelling of different types of organic foreign bodies has not been established, we aimed to analyze the hydroscopic properties of different organic foreign bodies in body temperature water.

Methods

Dry kidney beans, brown beans, peas, popcorn kernels, and dried fruits were soaked in a body temperature (37^oC) water bath. Volume of these organic materials was measured hourly to 8 hours, then at 12, 16, 24, 28, 36 and 48 hours.

Results

All dried fruits and beans increased in volume over time. The volume increase from baseline at 6 hours was between 43% (popcorn kernels) and 383% (kidney beans). Peas, popcorn, and raisins did not increase volume further after 6 hours. Kidney and brown beans had the greatest increase in volume overall (1268% and 482% respectively), and the greatest continued increase after 24 hours.

Conclusions

Many organic substances that frequently present as aural foreign bodies may swell enough in water to lodge tightly in the ear canal. Typical popcorn kernels and dried peas will not swell sufficiently to lodge tightly in the ear canal of a typical child one year or older. A retained organic foreign body in a moist ear canal may cause inflammation until the foreign body can be removed. These risks may be offset by the advantages of successful removal with irrigation.

Keywords

Foreign body; Irrigation; Organic; Ear; Hydroscopic; Procedure; Removal

Otomicroscope in the emergency department management of pediatric ear foreign bodies

OBJECTIVE

To determine the effect of a dedicated otomicroscope in the emergency department (ED) management of complex ear foreign bodies (FB).

METHODS

Prospective analysis of 85 patients with complex pediatric ear FB's.

RESULTS

65 (76%) of 85 FB's were successfully removed in the ED. 54 (63%) had previous attempted removal, 27 (31%) were less than age 4, 37 (44%) had ear FB's present longer than 24h, 3 (4%) had multiple ear FB's, and 9 (11%) had an external auditory canal (EAC) comorbidity prior to attempted removal. 31 (36%) were touching the tympanic membrane (TM). 20 (23%) had complications with removal with EAC laceration most common and no TM perforations or hematomas. Mean and median number of attempts for removal was 1.65 and 1.0. Successful removal was associated with the location of the FB, presence of an EAC comorbidity, and number of attempts (p<0.05). Complication rate was associated with an EAC comorbidity and number of attempts (p<0.05). EAC comorbidity was more common in FB's touching the TM (p<0.05). Increased number of attempts was associated with use of sedation (p<0.05).

CONCLUSIONS

The implementation of an otomicroscope into the ED resulted in successful removal of complex pediatric ear FB's with few attempts and a low rate of serious complications.