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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catheter is withdrawn (with the balloon inflated) to extract the object.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