Pediatric emergency medicine trisk 3261 3261

increased risk of inserting things in their ears Objects can cause trauma to the TM including possible perforation, and can disrupt the sensitive bony (medial) portion of the EAC, increasing the risk of infection Clinical Considerations Clinical Recognition Patients may present following a witnessed insertion of objects, the presence of otorrhea, decreased hearing, or pain In some cases, patients are asymptomatic and the foreign body is found incidentally during physical examination Objects may include stones, beads, foam, wax, paper, insects, or organic materials such as beans and popcorn kernels Ear foreign bodies are very common in children, especially those under years of age Triage The majority of children are well appearing, asymptomatic, or in mild/moderate pain Those with any bleeding from the ear or hearing loss require prompt evaluation Live insect foreign bodies are disconcerting and mineral oil or alcohol should be immediately instilled in the canal to euthanize them and stop further movement Initial Assessment The initial assessment should be focused on determining any history of object insertion, ear pain, or ear drainage as well as what type of object the foreign body might be This information is important for the removal plan Examination of the ear canal requires that the child remain very still to avoid advancing the foreign body or local trauma to the canal In addition to a handheld otoscope, a nasal speculum can be used to gently displace the tragus, and allow better visualization of the canal As with the otoscope, care must be taken when inserting the tines of the nasal speculum to prevent further insertion or impaction of the foreign body or injury to the canal skin Management Treatment focuses on safe removal of the foreign body (see Chapter 130 Procedures , Section on Ear Foreign Body Removal) In the emergency setting for the cooperative child, an ear curette can be used to scoop objects out or various otologic forceps (e.g., bayonet or alligator) can grasp objects Commercially available devices (e.g., Katz extractor) are available to help remove foreign bodies from the ear or nose When using these devices, a catheter is advanced