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A 3-year-old girl is brought by her parents to an urgent care facility after a day of crying, irritability, scant otorrhea, and frequent pulling of her right ear. Otoscopy reveals an erythematous, swollen external auditory canal (EAC) where a bead is wedged (Figure 28-1). The patient is referred to an otolaryngologist and the bead is removed using an operating microscope for visualization.

Figure 28-1

Foreign body (bead) in the ear canal of a 3-year-old girl with reactive tissue around it. (Courtesy of William Clark, MD.)

  • Children with ear foreign bodies (FBs) usually present with otalgia, otorrhea, or decreased hearing. At times, symptoms may be nonspecific, like irritability and crying. Other times, presentation may be asymptomatic.

  • Ear FBs are commonly seen in children ages 1 to 6 years.1-3
  • Equal male-to-female ratio in the pediatric population.4

  • Most common FBs in children include:5
  • Pathogenesis includes some of the key elements of otitis externa (see Chapter 27, Otitis Externa):
    • Initial breakdown of the skin-cerumen barrier (caused by presence of FB).
    • Skin inflammation and edema leading to subsequent obstruction of adnexal structures (e.g., cerumen glands, sebaceous glands, and hair follicles).
    • FB reaction leading to further skin injury.
    • In the case of alkaline battery electrochemical reaction, severe alkaline burns may occur.

Figure 28-2

Piece of a crayon in the ear canal of a 4-year-old boy. (Courtesy of William Clark, MD.)

Figure 28-3

Beach sand granules with exostosis in the ear of a cold water surfer. The exostoses are common in cold water swimmers and surfers. (Courtesy of Roy F. Sullivan, PhD. Audiology Forum: Video Otoscopy, www.rcsullivan.com.)

Figure 28-4

Ant in the ear canal. (Courtesy of Vladimir Zlinsky, MD in Roy F. Sullivan, PhD. Audiology Forum: Video Otoscopy, www.rcsullivan.com.)

  • Children with attention deficit hyperactivity disorder (ADHD) may be more likely to self-insert FBs and ADHD should be considered in children with ear FBs who are older than age 5 years.6

Clinical Features

  • Key historical features include:
    • Otalgia.
    • Otorrhea or otorrhagia.
    • Mild hearing loss.
    • Irritability, crying.
    • History suspicious for FB insertion or witnessed FB insertion.
  • Some children may be asymptomatic.
  • Hallmark of diagnosis includes visualization of FB on otoscopy (see Figures 28-1, 28-2, 28-3, and ...

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