Physicians are frequently called on to remove foreign bodies from the ears of pediatric patients. Ansley and Cunningham reviewed records of children who had presented with aural foreign bodies to determine how best to treat them.
Records of pediatric patients who presented with foreign bodies in their ears were reviewed to determine what the object was, the age of the child and how the object was removed (in what setting and with what instrument). Duration of the presence of the foreign body was also recorded when possible. Trauma was assessed to determine whether it was due to the foreign body or to the removal of the foreign body.
Most of the 191 patients included in this study were younger than eight years old. The most commonly found objects in the external auditory canal were beads, plastic toys, pebbles and insects. In about one quarter of the patients, the foreign body had been present for more than 24 hours. About one half of the patients sought assistance with removal of the object within 24 hours. Methods of removal included irrigation, suction or other instrumentation, sometimes with an operating microscope. Surgical removal with general anesthesia was necessary in nearly one third of patients. The most serious complication was severe damage to the external auditory canal caused by a disc battery, but other patients suffered abrasions and lacerations of the external auditory canal. Disc batteries are particularly troublesome since leakage of alkali electrolyte solution can cause liquefaction necrosis of the external auditory canal and the tympanic membrane, as well as direct-pressure necrosis. Attempted removal may cause bleeding, which wets the battery and allows leakage. Irrigation should never be used in an attempt to remove this type of battery from the external auditory canal.
The authors conclude that removal of aural foreign bodies is generally fairly straightforward if the foreign body is in the lateral one third of the external auditory canal and if sufficient staff support is available. On the other hand, attempted removal of foreign bodies in the medial two thirds of the external auditory canal may be much more painful (because of the vascularity of the skin overlying the periosteum in this portion of the ear canal), and otolaryngologic referral may be advisable. The authors provide summaries of recommendations for otolaryngologic referral and surgical extraction (see the accompanying tables).