Straighten the ear canal and visualize the foreign body directly with a speculum, ensuring the tympanic membrane is intact ( Fig 130.13C ) If the foreign body is spongy or could expand when wet, such as a bean or other food material, not use this method Do not attempt to remove a button battery with irrigation Remove the speculum and irrigate the ear canal by injecting a constant stream of water at body temperature Use a 20- to 50-mL syringe attached to flexible tubing (e.g., a cut section of tubing from a butterfly needle) Repeated irrigation may be necessary to provide complete emptying Day Ear Hook Visualize the foreign body with a speculum, preferably using an operating head otoscope or metal ear speculum Then, slowly advance the Day ear hook just beyond the foreign body Once beyond the foreign body, rotate the head of the hook 90 degrees to snag the foreign body Slowly withdraw the ear hook until the foreign body is removed Space to pass the tip of the ear hook beyond the foreign body is a prerequisite for success with this method This method should not be employed if the foreign body is immediately adjacent to the tympanic membrane Katz Extractor Visualize the foreign body with a speculum, preferably using an operating head otoscope or metal ear speculum Then, slowly advance the deflated balloon of the Katz extractor just beyond the foreign body as shown Once the deflated balloon is beyond the foreign body, depress the plunger on the syringe to inflate the balloon and slowly withdraw the extractor with the balloon inflated from the ear The foreign body will be forced out of the external auditory canal by the inflated balloon Space to pass the balloon beyond the foreign body is a prerequisite for success with this method This method should not be employed if the foreign body is immediately adjacent to the tympanic membrane ASPIRATION OF AN AURICULAR HEMATOMA Indications Traumatic auricular hematoma or seroma Complications Recurrent hematoma or seroma Infection (abscess) Procedure Restrain the child using a standard method if needed Palpate the hematoma to find the most fluctuant portion Cleanse the skin over the hematoma with antiseptic solution and allow to dry Topical anesthesia may be achieved with 4% lidocaine cream directly applied with an occlusive dressing 30 to 45 minutes before aspiration of the hematoma In very anxious children or those requiring a longer procedure, pharmacologic sedation should be considered Use a 10- or 20-mL syringe with an 18-gauge straight needle While stabilizing the syringe against the scalp with the nondominant gloved hand, puncture the most fluctuant portion of the hematoma with the needle ( Fig 130.14A,B ) Maintain negative pressure on the syringe plunger with one hand, while “milking” the hematoma with the thumb and index finger of the other Withdraw the needle after emptying the hematoma, but continue to maintain pressure on the auricle between the thumb and the finger for to minutes to tamponade any ongoing bleeding With wet cotton pledgets, reestablish the normal ear contours and apply a pressure or bolster dressing Arrange for follow-up in 12 to 24 hours to have the dressing unwrapped, check the ear, and redress FIGURE 130.13 Removal of a foreign body from the ear FIGURE 130.14 Aspiration of an auricular hematoma EVERSION OF THE EYELIDS Indications Identification of a foreign body or infection Instillation of medications to the conjunctiva Removal of a foreign body Complications Mild contusion or ecchymoses (rarely) Procedure If necessary for an uncooperative younger child, have an assistant restrain the patient on the examination table in the supine position with the arms wrapped around the head Alternatively, small infants can sit on the lap of a parent who then holds the infant’s head still Older cooperative patients may sit up for the procedure Once the eyelid is everted, removal of a foreign body can be accomplished Use a clean cotton-tipped swab and apply it to the foreign body to flick it from the conjunctival surface Upper Lid