Foreign Body, Ear

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  • Foreign bodies (FBs) lodged in the external auditory canal
  • The external auditory canal:
    • Cartilaginous and bony passage lined with periosteum and skin
    • The periosteum is extremely sensitive, making removal a painful procedure:
      • In small children general anesthesia may be required to remove the object
      • FBs usually impact at the junction of the inner end of the cartilaginous portion of the canal or at the isthmus
      • Innervated by the facial, glossopharyngeal, vagus nerves
  • Inanimate foreign objects are often associated with delayed presentations:
    • Children often delay reporting because of fear of punishment
    • Often the FB is an incidental finding in children during an ear exam
  • Physical findings may change due to length of time the object is in the canal
  • Children with cerumen impaction or those with pica are predisposed
  • The location is often the right ear, due to the predominance of right handedness
  • Children and psychiatric patients may insert anything sufficiently small to enter the external auditory canal.
  • Ear FBs are most common in children <8 yr
  • Complications:
    • Canal laceration:
      • Usually caused by repeated attempts to remove a nongraspable object
    • Perforation of tympanic membrane:
      • More likely to result from removal procedure than the FB
    • Otitis externa
    • Malocclusion from erosion into the temporomandibular joint
    • Parapharyngeal abscess
    • Mastoiditis
    • Meningitis
    • Brain abscess
    • Insects may injure the tympanic membrane or canal by stinging, biting, or scratching
    • Button batteries can cause significant destruction due to the strong electrical currents and pressure necrosis
    • Typically, the most damage is caused by negative side of the battery
    • Damage to the facial nerve and ossicles have been reported
  • Symptoms usually resolve within a few days after FB removal


  • Children:
    • Stones
    • Small beads
    • Paper
    • Toys
    • Seeds and popcorn kernels
    • Beans and other food and organic materials
    • Button batteries:
      • Higher risk for necrosis than other FBs
  • Competent adults:
    • Cotton-swab tips
    • Earplugs
    • Insects:
      • Cockroach most common in US
    • Hidden illicit drugs

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