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.
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
- Inanimate objects such as beads (see Figure 28-1), cotton tips, paper, toy parts, crayons (Figure 28-2), eraser tips, food, or organic matter, including sand (Figure 28-3), sticks, and stones.
- Insects (Figure 28-4).
- 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.
Piece of a crayon in the ear canal of a 4-year-old boy. (Courtesy of William Clark, MD.)
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.)
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
- Key historical features include:
- 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 28-4).
- Otoscopy may reveal signs of ...