Emergency Department and Primary Care Clinical Pathway for Evaluation/Treatment of Ear Foreign Body
Child with Suspected Foreign Body
in External Auditory Canal
in External Auditory Canal
-
Screening Questions
- Pain, drainage, bleeding
- Previous attempts
- Concern for
- Button battery
- Penetrating injury
- Living insect
- Expandable object
- KOPH Recommendations
- Tx to PHL
- Button battery
- Rapidly expandable object (water beads)
- Insect unable to be killed
- Severe pain
- Penetrating injury
- Expedited ENT referral
- Dead insect or non-expandable object
ED Triage
- Avoid irrigation until full evaluation
- Consider NPO, sedation needs
- Screening questions
- Notify Attending for suspected button battery
ED Team Assessment
- History and Physical
- Considerations for ENT Consultation
- Suspected button battery
- Penetrating injury
- Deep object against tympanic membrane (TM)
- Poor visualization
Procedure Preparation
- Child Life
- Anxiolysis, sedation as indicated
Button Battery
Expandable Object
Live Insect
Non-expandable Object
Avoid irrigation
- Avoid irrigation
- Expandable water beads
- Foam
- Organic matter
- Vegetable
- Popcorn kernel
- Instill 1 of the following if no TM injury
- Mineral oil
- Lidocaine
- Hydrogen peroxide
Immediate ENT Consult
Urgent Removal
- Removal Procedure Considerations
- Consider ENT Consult if sedation required
- Consult ENT if attempt unsuccessful
Consider Removal
- Shared decision making for expedited ENT referral or ED removal
- Removal Procedure
- Consider ENT Consult if sedation required
Foreign Body Successfully Removed
Foreign Body Not Removed
- Re-examine ear canal, tympanic membrane
- Topical antibiotics for TM trauma
- Concern for tympanic membrane perforation
- ENT Referral
- Avoid submersion in water
Expedited ENT Referral
Posted: March 2024
Editors: Clinical Pathways Team
Editors: Clinical Pathways Team
Evidence
- Ear Foreign Body Removal
- Removal of External Auditory Canal Foreign Bodies in the Pediatric Emergency Department - A Retrospective Comparison Study
- External Auditory Canal Foreign Body Extraction Outcomes
- Foreign Body Removal from the External Auditory Canal in a Pediatric Emergency Department
- Pediatric Ear Foreign Body Retrieval: A Comparison Across Specialties
- Pediatric External Auditory Canal Foreign Bodies: A Review of 698 Cases