External auditory canal foreign body removal: management practices and outcomes

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.

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.

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.

Management of Live Insects in the External Auditory Canal: A Wilderness Perspective

A live insect within the external auditory canal is an unpleasant possibility during wilderness recreation. To our knowledge, no study has attempted to quantify the risk of this event occurring in the wilderness. However, such events anecdotally seem to occur with some regularity in a variety of climates. Most cases are benign, but a small subset of patients can develop complications including infection, hearing loss, and vestibular complaints related to the foreign body. In the emergency department or clinic, removal of the insect is a simple procedure in most circumstances; however, the material and expertise required for backcountry removal of the insect are often limited. With this consideration in mind, we offer a conservative approach to backcountry insect removal based on a selective review of the published literature on this topic. Where published data are lacking, we make recommendations based on anecdotal experience of the authors dealing with this condition in austere environments and in the emergency department. We recommend insect removal only if the patient is acutely symptomatic and the insect is visualized and graspable with the instrument used for removal. In any other circumstance, intervention should be deferred until definitive care is reached because of risks of complications associated with removal, including infection, bleeding, and tympanic membrane damage.

Learning Curve of Upper Aerodigestive Tract Foreign Body Management for Otorhinolaryngology Residents

INTRODUCTION

Foreign body ingestion is the most common reason for otolaryngology specialist consultations in emergency departments. Among the different types of foreign bodies, fish bones are the most common, particularly in Asian populations. In Taiwan, upper aerodigestive tract foreign bodies (UADT-FBs) are mostly managed by residents in the otorhinolaryngology (ORL) department. Considering the learning curve required for all procedures, different management types between residents, and possible resulting safety issues, this study explored the outcomes of UADT-FB management by residents in different years of ORL training.

MATERIALS AND METHODS

The medical records of 2,283 patients who visited Kaohsiung Veterans General Hospital's Emergency Department for UADT-FB during June 2013-August 2019 were retrospectively reviewed. The reviewed data included the demographic data of enrolled patients, outcomes of foreign body management, and follow-up chart records of the patients.

RESULTS

Among the 2,283 patients, 1,324 (58%) were found to be negative for foreign bodies, and foreign bodies in 951 (41.7%) were removed immediately. In the negative finding (NF) group, 2 (4.9%) patients were later found to be positive for foreign bodies during follow-up in the outpatient department. One (2.4%) patient developed a deep neck infection and esophageal perforation. The percentage of NFs decreased from 62.58% in residents in the first half of their first year (R1a) to 54% for third-year residents (R3). Comparing R1a with R3, the number needed to harm for retained UADT-FBs after patients visited the emergency department was 12.2.

DISCUSSION/CONCLUSION

This study provides data from 1 referral center regarding the management of UADT-FBs. With increasing resident training, the percentage of NFs declined from 62.58 to 54%. Young residents, especially those in the first 6 months of their training, should have senior residents perform a second examination if UADT-FBs are not found in suspected cases.

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.

Management of foreign bodies in the ear, nose and throat in children: a review of 829 cases from Northern Anatolia

&lt;b&gt;Objective:&lt;/b&gt; The aim of this study was to evaluate cases of of ear, nose and pharyngeal (ENT) foreign body (FB) in pediatric patients referred to the pediatric emergency department of the Department of Otorhinolaryngology in Tokat State Hospital (Turkey). &lt;br&gt;&lt;b&gt;Methods:&lt;/b&gt; The paper comprises a retrospective study of all ENT foreign bodies presented to the pediatric emergency Department of Otorhinolaryngology in Tokat State Hospital (Turkey) between January 1, 2012 and December 31, 2018. Subject to evaluation were also demographic and clinical characteristics of the patients, types and anatomic locations of FBs, locations of FB by age groups, the method used to remove FBs and the distribution of FB cases by months. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; A total of 829 FB cases were evaluated in this study. The mean age of patients was 47.8 ± 31.4 months. Of all patients, 404 (48.5%) were male, and 425 (51.2%) were female. The nose (58.7%) and the ear (20.2%) were the most common anatomical locations followed by mouth/pharynx/tonsil (12.3%), esophagus (6.2%) and the laryngotracheobronchial tree (2.4%). The most common FBs in different locations were beads in the nose (30.8%), beads in the ear (32.1%), fishbones in the mouth/pharynx/tonsil (56.8%), nuts and peanuts in laryngotracheobronchial tree (70%) and a coin/disc battery in the esophagus (80.7%). &lt;br&gt;&lt;b&gt;Conclusion:&lt;/b&gt; FB in ENT is among the emergency conditions that require different diagnostic and treatment approaches based on anatomic localizations. Proper vision, adequate equipment and immobilization are important in the removal of ENT foreign bodies in children.

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.

Adult Popillia japonica as an Otorhinolaryngologic Invasive Foreign Body in a Rural Area

Otorhinolaryngologic foreign bodies may be encountered in-office visits, the emergency department, and speciality consultations. These include food, toys, and other small items, are present in pediatric patients. Because patients may be asymptomatic and the insertion of the foreign body not observed, obtaining medical care may be delayed. Conversely, insects as foreign bodies, especially in the external ear canal, can cause a patient significant pain and distress, directing the patient to seek immediate care. Here, we present a case of an adult Japanese beetle (Popillia japonica) as a foreign body in the ear of a 14-year-old female. A review of otorhinolaryngologic foreign bodies is also discussed, with particular attention to the ear and rural location. This case highlights the potential for agricultural insects to act as invasive foreign bodies, especially in areas where they are known to be endemic pests and the consequences of delayed treatment.

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.

Light-assisted removal of ear canal live insect-A noninvasive approach for first level responders

Physicians, working in the primary care setting and/or emergency departments, encounter more often patients of any age group with foreign bodies in the external auditory canal (EAC) and urgent removal is crucial to avoid complications. The condition is more commonly managed on an urgent basis if the foreign body is a live insect that is more agonizing for the patient. Foreign body removal is quite challenging but an essential skill for first-level responders and different approaches, each with its own pros and cons, are used for EAC foreign bodies removal. Herein, we report two cases that were managed safely by a noninvasive approach by using light illumination of EAC in complete darkness. The approach, not reported in the available literature, can be used as first-level management before opting another alternative, in settings where otolaryngologist services are not readily available.

Ear, nose, and throat foreign bodies in adults: A population-based study in Taiwan

BACKGROUND/PURPOSE

This study performed a population-based analysis in the managements of adult ear, nose, and throat FBs in Taiwan.

METHODS

The Taiwan Longitudinal Health Insurance Database 2000 were used, which comprises 1,000,000 beneficiaries randomly sampled in 2000 with a follow-up period from 2000 to 2013. Patients aged >18 years with ear, nose, or throat FB were identified according to the International Codes of Diseases.

RESULTS

In total, 94,312 adults with ear (n = 21,786), nose (n = 1007), throat (n = 62,986), airway (n = 419), or esophageal (n = 8114) FB were identified. Emergency department visits were most common among patients with esophageal or airway FB (33.3% and 25.1%, respectively). X-rays were most commonly performed for patients with esophageal FB (44.8%), and computed tomography (CT) was most commonly used for those with airway FB (4.3%). Hospitalization rate was the highest among patients with airway FB (7.4%), followed by those with esophageal (3.0%) and nose (0.7%) FB. Patients with airway FBs corresponded with the highest rate of intensive care unit stay (58.1%), longest hospital stay (10.5 days), and highest in-hospital mortality rate (25.8%). A multiple logistic regression model indicated that old age, medical comorbidities, undergoing CT, and airway or esophageal FB were associated with hospitalization among adults with FB.

CONCLUSION

Disparities were identified in the treatment of ear, nose, and throat FB in adults. This study provides population-based data that may serve as a reference for otolaryngologists in clinical FB management.

Preventative and medical treatment of ear disease in remote or resource-constrained environments

BACKGROUND

Important ear problems can affect the outer ear, the middle ear and the inner ear. Globally, the greatest burden of disease is due to ear conditions that are associated with otorrhoea and hearing loss.

METHODS

This study reviewed the literature on the prevention and treatment of common ear conditions that are most relevant to settings with high rates of ear disease and limited resources. The grading of recommendations assessment, development and evaluation ('GRADE') approach was utilised to assess interventions.

RESULTS

Accurate diagnosis of ear disease is challenging. Much of the preventable burden of ear disease is associated with otitis media. Nine otitis media interventions for which there is moderate to high certainty of effect were identified. While most interventions only provide modest benefit, the impact of treatment is more substantial in children with acute otitis media with perforation and chronic suppurative otitis media.

CONCLUSION

Disease prevention through good hygiene practices, breastfeeding, reducing smoke exposure, immunisation and limiting noise exposure is recommended. Children with acute otitis media with perforation, chronic suppurative otitis media, complications of otitis media, and significant hearing loss should be prioritised for medical treatment.

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.

ENT Foreign Bodies: An Experience

Introduction  Ear, nose and throat (ENT) foreign bodies (FBs) are common occurrences, particularly among children. The proper recognition, study, and management of FBs are required to prevent complications. Their consequences are greatly variable, from mild disturbances that may not require hospitalization up to life-threatening complications. Objective  To analyze the clinical spectrum of ENT FBs, the methods of removal, the outcomes and complications as seen in a tertiary referral hospital. Methods  This hospital-based cross-sectional retrospective study was performed from July 2014 to June 2016. Patients with any type of ENT FBs, regardless of age, were included in the study; data was collected from 1,013 patients (572 males and 440 females) with a mean age of 12.5 years. Results  Foreign bodies represented a large category among ENT emergencies (30%). Children were affected more frequently, particularly ≤ 6 years old. Swallowed FBs were the most common (53.6%), followed by aural FBs (24.68%), nasal FBs (19%), and inhaled FBs (2.6%). A total of 54.69% of ENT s were removed under general anesthesia (GA). Conclusion  Foreign bodies (FB) in the ears, nose or throat are a common occurrence in otorhinolaryngology (ENT) emergency services. Children are the most affected age group. The commonest site of FB lodgment is in the throat. Ear, nose and throat FBs need to be properly managed to avoid complications.

Aural Foreign Bodies Among Patients Presenting to Ibn Sina Teaching Hospital, Mukalla, Hadhramout Province, Yemen

Objective

To describe the types of aural foreign bodies (FBs) among patients in Ibn Sina Teaching Hospital (ISTH) and to study the patient's symptoms, duration, complications and procedures used to extract them.

Methods

A record based descriptive study was looked at patients with aural FBs at ISTH for 5 years between 2009 and 2015. The diagnosis of aural FBs was based on personal history, and otoscopic findings. The data were obtained from the records.

Results

Patients with aural FBs were 154, (age 1-70 years). Inorganic aural FBs were 100 (65%) and 54 (35%) were organic. Unilateral purulent aural discharge was in 72 (46.75%) patients, pain in 27 (17.53%), ear bleeding in 12 (7.8%), conductive hearing loss and tinnitus each was 8 (5.19%) and itching in 7 (4.55%). Duration of symptoms was <1 week in 55 (35.7%) cases, 1-2 weeks in 64 (41.6%) and 2-4 weeks in 29 (18.8%). Forceps, syringing, hook and suction were the tools used for removal of the FBs, 56 (36.4%), 40 (26.0%), 36 (23.4%), 14 (9.1%) respectively. FBs were removed under G.A. were 30 (19%). Complications were otitis externa in 38 (24.7%) cases, tympanic membrane perforation in 29 (18.85%) and external meatus laceration in 28 (18.20%).

Conclusion

The most common aural FBs found were inorganic (cotton tip, stone and eraser) and organic (fly, lice and bee). Complications were unilateral purulent discharge followed by pain and ear bleeding. FBs duration was from <1 to 4 weeks. The common procedures used were forceps, syringing, hook and suction. Particularly, organic vegetative FBs were removed under general anesthesia.

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.

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.

[Foreign bodies in ENT medicine]

A foreign body (Latin: corpus alienum) is any object originating outside the body. Of all specialties, otolaryngology covers the greatest number of natural body orifices, making foreign bodies a common diagnosis. Foreign bodies of the ear canal and nose often occur in children and are easily accessible during physical examination. Foreign bodies of the oral cavity and oropharynx are also easily removed. Esophageal and tracheobronchial foreign bodies are common in children and the elderly. A number of rigid and flexible endoscopic techniques are available for foreign body removal. In Germany, flexible endoscopy is six times more common than rigid endoscopy. Both methods are highly effective, and each has its advantages in certain situations. Rigid endoscopy is still a key in otolaryngology and can be used in case of failure of flexible techniques. It is therefore important for otolaryngologists to be proficient in both techniques.

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.

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.

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

Foreign body in the Eustachian tube: case presentation and technique used for removal

Foreign bodies of the external ear are very common; the same can not be said about foreign bodies of the middle ear, especially of the Eustachian tube.

Case presentation

Alcoholic and psychopathic patient presented a foreign body (barbecue wooden stick) purposefully introduced in his middle ear and Eustachian tube during an act of delinquency. The foreign body was stuck in the tube and could not be removed externally. It was surgically removed as described by the authors later on in the paper.

Comments

The patient recovered well, with no sequela on the facial nerve and without important vertigo.

Aural foreign bodies in children

OBJECTIVE

Foreign body in the ear is commonly encountered in children by primary care givers, emergency department Physicians, Pediatricians and Otolaryngologists worldwide.

METHODS

We reviewed cases of aural foreign bodies in children seen in our centre over a five-year period with the aim of auditing our current practice and suggesting possible improvements suited for developing countries.

RESULTS

Grains and seeds (27.9%), beads (19.7%), cotton wool (13.6%), paper (8.8%) and eraser (8.2%) formed the bulk of the aural foreign bodies. About 96% was removed without general anesthesia by using Jobson Horne's probe or aural dressing forceps (73.8%) under direct vision; or by syringing (22.1%). Some 4% had to be removed in the operating theatre under general anesthesia. The complications observed include bruise or laceration and bleeding from the external auditory canal (16.3%), otitis externa (6.5%) and traumatic perforation of the tympanic membrane (1.7%).

CONCLUSION

Despite a high proportion of cases managed in the office setting, complication rates were within acceptable levels. There is need to develop practical criteria that will be beneficial to primary health care givers to determine which patients could be managed in the primary care setting with acceptable outcome.

Foreign body in ear, nose and oropharynx: experience from a tertiary hospital

The ocurrence of foreign bodies in otorhinolaryngology is reason of constant searches for emergency services. Objective: To value the incidence of patients with foreign body, to analyze the clinical situation and the treatment in these cases. Method: The prospective study was realized in 81 patients with diagnosis of foreign body of nose, ear or oropharynx in the otorhinolaryngology service of the Hospital do Servidor Público Municipal de São Paulo between april/2003 and march/2005. Results: 57 cases of foreign body of ear, 13 cases of nose and 11 of oropharynx. These patients, 51.85% were men and 48.15% were women. The age average was 23 years old. The average of the evolution time was 18.36 days, being that 38.27% these cases were taken care in less 24 hours of evolution. Inside the total of patients, 83.95% received initial attendance in the otorhinolaryngology clinic, and 16.05% came of another service after some previous removal attempt. The most common symptom of the foreign bodies cases of oropharynx it was odinofagia present in 90.91% of the cases; in the foreign bodies of nose, the unilateral rhinorrhea and cacosmia were present in 46.15 of the cases; in the foreign bodies of ear, 38.60% evolved without symptoms and 28.07 with hipoacusia. The most frequent foreign body of oropharynx it was the fish spine (54.55%); in the nose it was the paper (30.77%); and in the ear it was the cotton (31.58%). The complications resulting of the presence of foreign body or about the manipulation of these had been found in 13 cases (16.05%). Conclusion: Most cases of foreign body conditions, in which a non-specialist professional or a non-professional person previously handles its removal, have a bad evolution with emerging complications. Such outcomes strengthen the fact that an otorhinolaryngologist using the proper equipment must treat patients with foreign body.

Ear, nose and throat foreign bodies in Melanesian children: an analysis of 1037 cases

OBJECTIVE

Occurrence of foreign bodies (FBs) in ear, nose and throat (ENT) in children are not uncommon in clinical practice. We described our experience with ENT foreign bodies in Melanesian children.

METHOD

The study was carried out at the tertiary referral center which is also a University teaching hospital. The 15-year period from 1990 to 2004, 1037 cases of ENT foreign bodies were managed. The clinical, operative and follow up data of these patients were collected from available clinic cards and admission charts. A retrospective analysis was made with these data.

RESULTS

Foreign bodies in the external auditory canal constituted 711 (68.6%) cases. It was followed by nose in 258 (24.9%), pharynx in 26 (2.5%), esophagus in 21 (2.0%) and laryngotracheobronchial (LTB) tree in 21 (2.0%) cases. Innumerable varieties of foreign bodies were removed from the ear. The common ones were stones in 277 (39.0%), seeds in 142 (20.0%), plastic ornament beads in 70 (9.8%) and cotton in 48 (6.8%) cases. Six hundred and thirteen (86.2%) of them were removed under microscope at the clinic without any complications. The difficult ones in uncooperative children were removed in the operation theatre. They numbered 98 (13.8%). The nasal foreign bodies were exclusively limited up to the age of 12 years. Common nasal foreign bodies were foam in 54 (20.9%), seeds in 51 (19.8%), stone in 28 (10.9%) and ornament beads in 24 (9.3%) cases. Two hundred and forty-six (95.3%) of them were removed in the clinic. Only 12 (4.7%) were removed in the operation theatre. Fishbone was the commonest (23, 90.2%) foreign body encountered in the pharynx of the children. Coins were the exclusive esophageal foreign bodies in children and all were removed in the operation theatre under general anesthesia. In the LTB tree the FBs were mostly localized to the right main bronchus which occurred in 11 (52.4%) cases. This was followed by the trachea in four (19.1%) cases. The different types of FBs encountered were coffee beans in eight (38.0%), peanuts in five (23.8%), plant seeds in three (14.2%) cases. We encountered two mortalities in these LTB FB patients.

CONCLUSIONS

Otolaryngological foreign bodies in children are common. For early diagnosis a high index of suspicion has to be maintained by pediatric otolaryngologist.

Corpo estranho de orelha, nariz e orofaringe: experiência de um hospital terciário

A ocorrência de corpos estranhos em otorrinolaringologia é motivo de freqüentes consultas em serviços de emergência. OBJETIVO: Avaliar a incidência de pacientes com corpo estranho, bem como analisar o quadro clínico e o tratamento nestes casos. MÉTODO: Foi realizado estudo prospectivo de 81 pacientes com diagnóstico de corpo estranho de nariz, orelha ou orofaringe admitidos no Serviço de Otorrinolaringologia do Hospital do Servidor Público Municipal de São Paulo, no período de abril de 2003 a março de 2005. RESULTADOS: Foram 57 casos de corpo estranho de orelha; 13 de cavidade nasal; e 11 de orofaringe. Destes pacientes, 51,85% foram do sexo masculino e 48,15% do sexo feminino. A média de idade foi de 23 anos. A média do tempo de evolução foi de 18,36 dias, sendo que 38,27% dos casos foram atendidos com menos de 24 horas de evolução. Do total de pacientes, 83,95% receberam atendimento inicial na clínica de otorrinolaringologia, e 16,05% vieram encaminhados de outro serviço após alguma tentativa de remoção prévia. O sintoma mais comum dos casos de corpos estranhos de orofaringe foi a odinofagia presente em 90,91% dos casos; nos corpos estranhos de nariz, a rinorréia unilateral e cacosmia estiveram presentes em 46,15% dos casos; e nos corpos estranhos de orelha, 38,60% evoluíram sem sintomas, e 28,07% com hipoacusia. O corpo estranho mais freqüente de orofaringe foi a espinha de peixe (54,55%); no nariz foi o papel (30,77%); e na orelha foi o algodão (31,58%). As complicações decorrentes da presença de corpo estranho ou da manipulação dos mesmos foram encontradas em 13 casos (16,05%). CONCLUSÃO: A maioria dos casos com manipulação prévia para remoção de corpo estranho por profissional não-habilitado ou por leigo evoluiu com complicações, enfatizando que o manejo dos pacientes com corpo estranho deve ser realizado pelo médico otorrinolaringologista e com o uso de material adequado.