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Curry SD, Maxwell AK. Management of Foreign Bodies in the Ear Canal. Otolaryngol Clin North Am 2023; 56:881-889. [PMID: 37516654 DOI: 10.1016/j.otc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
Using the appropriate instruments and techniques for removing a foreign body from the external auditory canal facilitates the procedure and reduces the risk of complications. Most ear foreign bodies can be addressed on a nonurgent basis, but batteries and caustic materials warrant prompt removal. Referral to an otolaryngologist should be considered for difficult cases or after a failed attempt.
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Affiliation(s)
- Steven D Curry
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, 981225 Nebraska Medical Center, Omaha, NE 68198-1225, USA
| | - Anne K Maxwell
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, 981225 Nebraska Medical Center, Omaha, NE 68198-1225, USA.
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White AC, Shih MC, Nguyen SA, Carol Liu YC. Comparison of Care Settings for Pediatric External Auditory Canal Foreign Bodies: A Meta-Analysis. Ann Otol Rhinol Laryngol 2023; 132:322-331. [PMID: 35499131 DOI: 10.1177/00034894221093584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the success and complication rates of pediatric external auditory canal foreign body (EAC FB) removal between Emergency Departments (ED), Primary Care Providers (PCP), and Otolaryngologists (ENT). METHODS PubMed, Scopus, and Embase were searched through January 13, 2022. Studies mentioning EAC FB removal success rates and types of healthcare settings were included. Pooled measures included abrasions/lacerations, TM perforations, and success rate stratified by healthcare setting. RESULTS Thirteen studies and 3891 patients were included in the meta-analysis. Most comparisons between EAC FB removal success rates for EDs versus PCPs versus ENTs were statistically significant. The highest FB removal success rate was in patients who presented to ENTs without previous removal attempts (92.9% [95% CI 84.6-98.2]). EDs had the lowest success rates (64.0% [95% CI 48.3-78.3]). For patients that had a previous attempt at FB removal, ENTs had a success rate of 64.1% [95% CI 42.0-83.5]. CONCLUSIONS For ENTs treating pediatric EAC FB, removal success rates decrease if a different healthcare provider previously attempted EAC FB removal. This effect likely is due to decreased patient cooperativeness or increased FB complications (eg, canal edema and bleeding limiting visualization) after previous removal attempts. Individual institutions should identify conditions that increase EAC FB removal failure rates and necessitate ENT referral. Therefore, the communication and concerted efforts between EDs, PCPs, and ENTs are critical for the improved outcomes of pediatric EAC FBs.
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Affiliation(s)
- Ana C White
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.,University of Georgia, Athens, GA, USA
| | - Michael C Shih
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Yi-Chun Carol Liu
- Baylor College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Houston, TX, USA.,Texas Children's Hospital, Division of Pediatric Otolaryngology, Houston, TX, USA
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Giltmier A, Aunins B, Ishman SL, Roche C. Management of Live Insects in the External Auditory Canal: A Wilderness Perspective. Wilderness Environ Med 2022; 33:318-323. [PMID: 35644737 DOI: 10.1016/j.wem.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 03/10/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Abstract
A live insect within the external auditory canal is an unpleasant possibility during wilderness recreation. To our knowledge, no study has attempted to quantify the risk of this event occurring in the wilderness. However, such events anecdotally seem to occur with some regularity in a variety of climates. Most cases are benign, but a small subset of patients can develop complications including infection, hearing loss, and vestibular complaints related to the foreign body. In the emergency department or clinic, removal of the insect is a simple procedure in most circumstances; however, the material and expertise required for backcountry removal of the insect are often limited. With this consideration in mind, we offer a conservative approach to backcountry insect removal based on a selective review of the published literature on this topic. Where published data are lacking, we make recommendations based on anecdotal experience of the authors dealing with this condition in austere environments and in the emergency department. We recommend insect removal only if the patient is acutely symptomatic and the insect is visualized and graspable with the instrument used for removal. In any other circumstance, intervention should be deferred until definitive care is reached because of risks of complications associated with removal, including infection, bleeding, and tympanic membrane damage.
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Affiliation(s)
- Andrew Giltmier
- University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Benjamin Aunins
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stacey L Ishman
- University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Conal Roche
- University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Schwanke L, Chen D, Lomiguen CM, Chin J. Adult Popillia japonica as an Otorhinolaryngologic Invasive Foreign Body in a Rural Area. Cureus 2020; 12:e12046. [PMID: 33447476 PMCID: PMC7802398 DOI: 10.7759/cureus.12046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Otorhinolaryngologic foreign bodies may be encountered in-office visits, the emergency department, and speciality consultations. These include food, toys, and other small items, are present in pediatric patients. Because patients may be asymptomatic and the insertion of the foreign body not observed, obtaining medical care may be delayed. Conversely, insects as foreign bodies, especially in the external ear canal, can cause a patient significant pain and distress, directing the patient to seek immediate care. Here, we present a case of an adult Japanese beetle (Popillia japonica) as a foreign body in the ear of a 14-year-old female. A review of otorhinolaryngologic foreign bodies is also discussed, with particular attention to the ear and rural location. This case highlights the potential for agricultural insects to act as invasive foreign bodies, especially in areas where they are known to be endemic pests and the consequences of delayed treatment.
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Affiliation(s)
- Lindsey Schwanke
- Primary Care, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Derek Chen
- Primary Care, Lake Erie College of Osteopathic Medicine, Greensburg, USA
| | | | - Justin Chin
- Medical Education, Lake Erie College of Osteopathic Medicine, Erie, USA.,Family Medicine, LifeLong Medical Care, Richmond, USA
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Xiao CC, Kshirsagar RS, Rivero A. Pediatric foreign bodies of the ear: A 10-year national analysis. Int J Pediatr Otorhinolaryngol 2020; 138:110354. [PMID: 33152957 DOI: 10.1016/j.ijporl.2020.110354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To estimate the incidence of emergency department visits for pediatric ear foreign bodies. To identify the most common items and their trends. METHODS The Nationwide Electronic Injury Surveillance System (NEISS) was queried for emergency department visits involving the diagnosis of foreign bodies in the ear including pinna and canal in children over the most recent 10-year span available. National incidence estimates and demographic data were extracted from the same database. RESULTS Ear foreign bodies in children made up an estimated total 446,819 ED visits nationwide over the past 10 years. The mean age was 7.2 ± 4.3 years old. The majority (55.6%, n = 248,531) of cases were female. The most common class of objects found was jewelry, primarily embedded earrings and beads, accounting for 55.5% visits, followed by paper products at 7.1%, pens and pencils at 4.1%, desk supplies (erasers) at 3.7%, BBs or pellets at 3.5%, and earplugs and earphones at 3%. Females were significantly more likely to have jewelry foreign bodies, and males were significantly more likely to have foreign bodies from all other categories other than first-aid supplies. CONCLUSION Foreign bodies of the ear are a common reason for emergency department visits in children, primarily jewelry, paper products, and desk supplies. Recognition of commonly encountered objects can aid in both speedier recognition of unknown objects, as well as guide patient counseling.
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Affiliation(s)
- Christopher C Xiao
- Head and Neck Surgery Department, Kaiser Permanente Oakland Medical Center, United States.
| | - Rjiul S Kshirsagar
- Head and Neck Surgery Department, Kaiser Permanente Oakland Medical Center, United States
| | - Alexander Rivero
- Head and Neck Surgery Department, Kaiser Permanente Oakland Medical Center, United States
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Kim KH, Chung JH, Byun H, Zheng T, Jeong JH, Lee SH. Clinical Characteristics of External Auditory Canal Foreign Bodies in Children and Adolescents. EAR, NOSE & THROAT JOURNAL 2019; 99:648-653. [PMID: 31814447 DOI: 10.1177/0145561319893164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Foreign bodies (FBs) in external auditory canal (EAC) can occur at any age but are especially common in children and adolescents. The aims of the study were to evaluate the clinical characteristics of EAC FBs in children and adolescents and to discuss their proper management. METHODS A retrospective medical chart review was performed on patients who were treated for EAC FBs in a tertiary referral center from January 2007 to December 2017. We investigated the parameters of age, sex, type of FB, sedation method, complications, and removal strategy. RESULTS Of 284 patients, 176 (62.0%) were male. Peak incidences were noted at the ages of 3 to 6 years and 17 to 18 years. The frequently observed FBs were insects, followed by air-gun pellets, cotton balls, marbles, and earrings. Forty-one (14.4%) EAC FBs were removed with the naked eye, while 243 (85.6%) were removed under microscope in the otolaryngology department. Of these patients, 23 (9.5%) were administered sedatives and 1 (4.1%) needed general anesthesia. During or after the removal procedure, 4 (15.5%) patients had complications of EAC abrasion or laceration (42, 14.8%), and tympanic membrane perforation (2, 0.7%). CONCLUSIONS External auditory canal FB showed a distinct characteristic of incidence regarding age, related to removal strategies. Characteristics of FB must be considered for safe removal.
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Affiliation(s)
- Keon-Ho Kim
- Department of Otolaryngology-Head and Neck Surgery, 37992College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jae Ho Chung
- Department of Otolaryngology-Head and Neck Surgery, 37992College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Hayoung Byun
- Department of Otolaryngology-Head and Neck Surgery, 37992College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Tao Zheng
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Chang Chun, PR China
| | - Jin-Hyeok Jeong
- Department of Otolaryngology-Head and Neck Surgery, 37992College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Seung Hwan Lee
- Department of Otolaryngology-Head and Neck Surgery, 37992College of Medicine, Hanyang University, Seoul, Republic of Korea
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Alfaifi AJ, Khan LA, Mokarbesh HM. Light-assisted removal of ear canal live insect-A noninvasive approach for first level responders. J Family Med Prim Care 2019; 8:3042-3044. [PMID: 31681691 PMCID: PMC6820391 DOI: 10.4103/jfmpc.jfmpc_443_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/01/2019] [Accepted: 09/05/2019] [Indexed: 11/26/2022] Open
Abstract
Physicians, working in the primary care setting and/or emergency departments, encounter more often patients of any age group with foreign bodies in the external auditory canal (EAC) and urgent removal is crucial to avoid complications. The condition is more commonly managed on an urgent basis if the foreign body is a live insect that is more agonizing for the patient. Foreign body removal is quite challenging but an essential skill for first-level responders and different approaches, each with its own pros and cons, are used for EAC foreign bodies removal. Herein, we report two cases that were managed safely by a noninvasive approach by using light illumination of EAC in complete darkness. The approach, not reported in the available literature, can be used as first-level management before opting another alternative, in settings where otolaryngologist services are not readily available.
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Affiliation(s)
- Amal Jaber Alfaifi
- Department of Family Medicine, Ministry of Health, Jazan, Kingdom of Saudi Arabia
| | - Liaqat Ali Khan
- Department of Otolaryngology, King Fahad Central Hospital Jazan, Kingdom of Saudi Arabia
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