ear, nose, and throat disorders
External Ear Obstructions
Foreign bodies in the ear
Foreign bodies are common, particularly among children, who often insert objects, particularly beads, erasers, and beans, into the ear canal. Foreign bodies may remain unnoticed until they provoke an inflammatory response, causing pain, itching, infection, and foul-smelling, purulent drainage. In general, foreign bodies that appear easy to grasp and remove (eg, paper, an insect wing) can be removed with alligator forceps by most practitioners. However, forceps tend to push round, smooth objects (eg, beads, beans) deeper into the canal. Patients with such objects should be referred to an otolaryngologist if the object cannot be easily removed with a curette. If a smooth, rounded, or spherical foreign body is lateral to the isthmus (bony-cartilaginous junction), it should be removed by reaching behind the object and rolling it out. Foreign bodies medial to the isthmus should be removed under operating microscope guidance by a specialist. Without a microscope, a foreign body lying at or medial to the isthmus (the bony cartilaginous junction of the external auditory canal) is difficult to remove without injuring the delicate canal skin, tympanic membrane, or ossicular chain. Referral to an otolaryngologist also is indicated for an uncooperative child, who may require sedation, or for failed attempts at removal. Irrigation is not recommended for foreign body removal; hygroscopic foreign bodies (eg, beans or other vegetable matter) swell when water is added, complicating removal. A general anesthetic or deep sedation may be needed when a child cannot remain still or when removal is difficult, threatening injury to the tympanic membrane or ossicles. Further, if manipulating a presumed foreign object results in bleeding, further attempts at removal should stop and immediate otolaryngologic consultation should be sought. Bleeding may indicate a laceration of the canal skin or that the foreign body is actually a middle ear polyp. Insectsin the canal are most annoying while alive. Filling the canal with viscouslidocaine(or alcohol if the eardrum is intact) kills the insect, which provides immediate relief and allows the immobilized insect to be removed with forceps by grasping a wing or leg. 