behind the object, the balloon is inflated on the distal side of the object, and the catheter is withdrawn (with the balloon inflated) to extract the object Body temperature water can be used to irrigate and remove objects against the TM, provided the TM is intact Avoid irrigating organic objects (e.g., food, paper) as they can swell and become further lodged in the EAC Insects should be euthanized by instilling alcohol or mineral oil into the canal before attempting to remove them, again provided the TM is intact To reduce pain for these procedures a topical anesthetic can be applied in advance If the child is uncooperative with the procedure, there is risk of further damage to the EAC or TM, and procedural sedation in the ED could be considered Removal in the ED with sedation has the same safety profile as OR removal, potentially with lower cost Following successful removal, if there is excoriation or trauma to the EAC, topical combination antibiotic and steroid otic drops should be used to prevent otitis externa and to help decrease any inflammation Over-the-counter pain analgesia can be used for any minor discomfort If the foreign body cannot be successfully removed and there are no concerns for pain, bleeding, or infection, patients may be referred for removal by an otolaryngologist either in an ED that can provide procedural sedation or in a day surgery setting Ear Trauma Goals of Treatment The primary goal of treating ear trauma is to prevent cosmetic defects that could result from the injury and hearing loss, which is associated with lifelong disability In addition, optimal management of ear trauma reduces local infection risk, which, if left untreated, could result in cartilaginous infections and lead to worsened cosmetic appearance CLINICAL PEARLS AND PITFALLS Auricular hematomas should be identified and treated promptly Unrecognized traumatic perforation of the TM can lead to serious complications A thorough assessment of hearing including gross hearing, whisper test, and tuning fork assessment for both conductive and sensorineural hearing loss should be performed on all children with ear injuries EXTERNAL EAR