Object in ear
Parents brought their 3-year-old daughter to an urgent care facility because she had been crying all day. The child was irritable, had scant otorrhea, and had been pulling on her right ear. Otoscopy revealed an erythematous, swollen external auditory canal and a foreign object.
How would you care for this patient?
The parents told the family physician that their child had been playing with a toy beaded necklace when she started crying. The patient was referred to an otolaryngologist, who removed the bead using an operating microscope for visualization. She evaluated the child for a co-existing otitis externa and decided that the external canal was markedly inflamed and probably infected. The otolaryngologist prescribed Corticosporin Otic Suspension to treat the inflammation and infection. This preparation includes a topical steroid along with topical antibiotics. The child did well on the medication.
Ear foreign bodies (FBs) are commonly seen in children ages 1 to 6 years. The most common FBs in children include beads, cotton tips, paper, toy parts, crayons, eraser tips, food, or organic matter (eg, sand, sticks, stones). Ear irrigation may be attempted in the office if the object is not a battery or vegetable matter, and there is no evidence of a perforated tympanic membrane.
Referral to otolaryngology should be considered when:
- More than one attempt to remove the object has been carried out without success.
- Patients have firm rounded FBs (as was the case with this patient).
- Patients have FBs with smooth, non-graspable surfaces (also the case with this patient).
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Rayala, B. Ear: foreign body. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:185-188.
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