Diagnosis and management of foreign bodies of the outer ear
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Department of Otolaryngology, Head and Neck Surgery and Pediatrics
- Lewis Katz School of Medicine at Temple University
- Aderonke Ojo, MD
Aderonke Ojo, MD
- Associate Professor of Pediatric Emergency Medicine
- Baylor College of Medicine
- Section Editor
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Embedded earrings in the earlobe or cartilaginous portions of the pinna and external auditory canal (EAC) foreign bodies are common problems encountered by primary care and emergency physicians. Physical examination provides the diagnosis in most patients.
Successful removal of foreign bodies of the pinna requires appropriate analgesia using local anesthesia or procedural sedation. Local infection and perichondritis frequently complicate these foreign bodies.
Proper restraint, adequate illumination, and appropriate equipment are essential for successful extraction of foreign bodies of the EAC. Complex EAC foreign bodies (eg, button batteries, objects up against the tympanic membrane, or those associated with injury to the tympanic membrane or middle ear) warrant prompt referral to an otolaryngologist.
This topic discusses the diagnosis and management of foreign bodies of the outer ear. The evaluation and management of lacerations of the ear are discussed separately. (See "Assessment and management of auricle (ear) lacerations".)
FOREIGN BODIES OF THE PINNA
Clinical anatomy — Foreign bodies of the pinna usually arise from embedded pierced earrings. These may be located in the earlobe or the cartilaginous portions of the pinna (figure 1). Local contact dermatitis to gold-plated or metal alloy studs, poor hygiene, and constant pressure caused by fixing clips create local swelling at the piercing site. Subsequently, skin ischemia, inflammation, and decubitus ulcer formation develop along with penetration of a portion or the entire earring into the pinna [1,2].
- Fijałkowska M, Pisera P, Kasielska A, Antoszewski B. Should we say NO to body piercing in children? Complications after ear piercing in children. Int J Dermatol 2011; 50:467.
- de San Lazaro C, Jackson RH. Vanishing earrings. Arch Dis Child 1986; 61:606.
- Timm N, Iyer S. Embedded earrings in children. Pediatr Emerg Care 2008; 24:31.
- Martinez NJ, Friedman MJ. External ear procedures. In: Textbook of Pediatric Emergency Procedures, 2nd, King C, Henretig FM. (Eds), Lippincott, Williams & Wilkins, Philadelphia 2008. p.593.
- Sandhu A, Gross M, Wylie J, et al. Pseudomonas aeruginosa necrotizing chondritis complicating high helical ear piercing case report: clinical and public health perspectives. Can J Public Health 2007; 98:74.
- Stewart GM, Thorp A, Brown L. Perichondritis--a complication of high ear piercing. Pediatr Emerg Care 2006; 22:804.
- Fisher CG, Kacica MA, Bennett NM. Risk factors for cartilage infections of the ear. Am J Prev Med 2005; 29:204.
- Marin JR, Trainor JL. Foreign body removal from the external auditory canal in a pediatric emergency department. Pediatr Emerg Care 2006; 22:630.
- Weiser M, Levy A, Neuman M. Ear stuffing: an unusual form of self-mutilation. J Nerv Ment Dis 1993; 181:587.
- Ansley JF, Cunningham MJ. Treatment of aural foreign bodies in children. Pediatrics 1998; 101:638.
- Das SK. Aetiological evaluation of foreign bodies in the ear and nose. J Laryngol Otol 1984; 98:989.
- Celenk F, Gokcen C, Celenk N, et al. Association between the self-insertion of nasal and aural foreign bodies and attention-deficit/hyperactivity disorder in children. Int J Pediatr Otorhinolaryngol 2013; 77:1291.
- Peridis S, Athanasopoulos I, Salamoura M, et al. Foreign bodies of the ear and nose in children and its correlation with right or left handed children. Int J Pediatr Otorhinolaryngol 2009; 73:205.
- Fasunla AJ, Ogunleye OO, Ijaduola TG. Healthcare givers' skill and foreign bodies in the ears of children in the tropics. Int J Pediatr Otorhinolaryngol 2007; 71:191.
- Mukherjee A, Haldar D, Dutta S, et al. Ear, nose and throat foreign bodies in children: a search for socio-demographic correlates. Int J Pediatr Otorhinolaryngol 2011; 75:510.
- Lossos IS, Breuer R. A rare case of hiccups. N Engl J Med 1988; 318:711.
- Kavanagh KT, Litovitz T. Miniature battery foreign bodies in auditory and nasal cavities. JAMA 1986; 255:1470.
- Premachandra DJ, McRae D. Severe tissue destruction in the ear caused by alkaline button batteries. Postgrad Med J 1990; 66:52.
- Bhisitkul DM, Dunham M. An unsuspected alkaline battery foreign body presenting as malignant otitis externa. Pediatr Emerg Care 1992; 8:141.
- Supiyaphun P, Sukumanpaiboon P. Acute otalgia: a case report of mature termite in the middle ear. Auris Nasus Larynx 2000; 27:77.
- Leffler S, Cheney P, Tandberg D. Chemical immobilization and killing of intra-aural roaches: an in vitro comparative study. Ann Emerg Med 1993; 22:1795.
- Antonelli PJ, Ahmadi A, Prevatt A. Insecticidal activity of common reagents for insect foreign bodies of the ear. Laryngoscope 2001; 111:15.
- Smith M, Darrat I, Seidman M. Otologic complications of cotton swab use: one institution's experience. Laryngoscope 2012; 122:409.
- Talmi YP, Wolf M, Migirov L, Kronenberg J. Ear trauma caused by a yucca plant leaf spine. Ear Nose Throat J 2009; 88:E11.
- Singh GB, Sidhu TS, Sharma A, et al. Management of aural foreign body: an evaluative study in 738 consecutive cases. Am J Otolaryngol 2007; 28:87.
- Schulze SL, Kerschner J, Beste D. Pediatric external auditory canal foreign bodies: a review of 698 cases. Otolaryngol Head Neck Surg 2002; 127:73.
- Thompson SK, Wein RO, Dutcher PO. External auditory canal foreign body removal: management practices and outcomes. Laryngoscope 2003; 113:1912.
- Marin JR, Trainor JL. Foreign body removal from the external auditory canal in a pediatric emergency department. Pediatr Emerg Care 2006; 22:630. (cross reference).
- DiMuzio J Jr, Deschler DG. Emergency department management of foreign bodies of the external ear canal in children. Otol Neurotol 2002; 23:473.
- Cederberg CA, Kerschner JE. Otomicroscope in the emergency department management of pediatric ear foreign bodies. Int J Pediatr Otorhinolaryngol 2009; 73:589.
- Steele D. Foreign body removal from the external auditory canal. In: Textbook of Pediatric Emergency Procedures, 2nd edition, King C, Henretig FM. (Eds), Lippincott, Williams & Willkins, Philadelphia 2008. p.589.
- Dinsdale RC, Roland PS, Manning SC, Meyerhoff WL. Catastrophic otologic injury from oral jet irrigation of the external auditory canal. Laryngoscope 1991; 101:75.
- Brown L, Denmark TK, Wittlake WA, et al. Procedural sedation use in the ED: management of pediatric ear and nose foreign bodies. Am J Emerg Med 2004; 22:310.
- Isaacson G. Two-stage removal of an impacted foreign body with an epoxied anchor. Ann Otol Rhinol Laryngol 2003; 112:777.
- McLaughlin R, Ullah R, Heylings D. Comparative prospective study of foreign body removal from external auditory canals of cadavers with right angle hook or cyanoacrylate glue. Emerg Med J 2002; 19:43.
- Abadir WF, Nakhla V, Chong P. Removal of superglue from the external ear using acetone: case report and literature review. J Laryngol Otol 1995; 109:1219.
- Persaud R. A novel approach to the removal of superglue from the ear. J Laryngol Otol 2001; 115:901.
- Balbani AP, Sanchez TG, Butugan O, et al. Ear and nose foreign body removal in children. Int J Pediatr Otorhinolaryngol 1998; 46:37.
- Bressler K, Shelton C. Ear foreign-body removal: a review of 98 consecutive cases. Laryngoscope 1993; 103:367.
- Friedman EM. VIDEOS IN CLINICAL MEDICINE. Removal of Foreign Bodies from the Ear and Nose. N Engl J Med 2016; 374:e7.
- FOREIGN BODIES OF THE PINNA
- Clinical anatomy
- Clinical manifestations and diagnosis
- Treatment of infection
- FOREIGN BODIES OF THE EXTERNAL AUDITORY CANAL (EAC)
- Clinical anatomy
- Clinical manifestations and diagnosis
- Differential diagnosis
- - Timing
- - Indications for consultation or referral to a specialist
- - Procedure
- Instrumentation under direct visualization
- Cyanoacrylate glue occlusion
- - Complications
- ADDITIONAL RESOURCES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS