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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 5 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