1 Abrasion of the external auditory canal Perforation of the tympanic membrane Ossicular disruption Procedure Multiple methods are available for removal of a foreign body from the external auditory canal; all require cooperation from, or restraint of, the child Pharmacologic sedation may facilitate safe performance of the procedure, but extreme caution must be exercised in a sedated patient in order to avoid damage to structures of the middle ear Objects lying on or near the tympanic membrane should be referred to an otolaryngologist Inorganic materials, with the notable exception of button batteries, may not require emergent removal and can be referred for elective removal Whenever possible, foreign bodies should be removed under direct visualization in order to avoid complications Minor abrasion and laceration of the external auditory canal is often unavoidable during the procedure, and parents should be made aware of this complication before beginning the procedure After removal of the foreign body or cerumen by any method, it is important to visualize the tympanic membrane and document its condition Curette Visualize the foreign body with a speculum, preferably using an operating head otoscope or metal ear speculum ( Fig 130.13A ) Then, slowly advance the curette just beyond the foreign body as shown While applying pressure to the foreign body, slowly withdraw the curette until the foreign body is removed Space to pass the tip of the curette beyond the foreign body is a prerequisite for success with this method Forceps Visualize the foreign body with a speculum, preferably using an operating head otoscope or metal ear speculum, and look for a protruding edge of the foreign material ( Fig 130.13B ) Carefully guide the forceps in the closed position under direct visualization through the speculum Just a few millimeters from the edge of the foreign body, open the forceps and grasp the edge gently Withdraw the forceps while maintaining visualization of the foreign body and the external auditory canal to minimize the chance of a complication Irrigation