A 3-year-old girl is brought by her parents to an urgent care facility after a day of crying, irritability, scant otorrhea, and frequent pulling of her right ear. Otoscopy reveals an erythematous, swollen external auditory canal (EAC) where a bead is wedged (Figure 30-1). The patient is referred to an otolaryngologist and the bead is removed using an operating microscope for visualization.
Foreign body (bead) in the ear canal of a 3-year-old girl with reactive tissue around it. (Reproduced with permission from William Clark, MD.)
Children with ear foreign bodies (FBs) usually present with otalgia, otorrhea, or decreased hearing. At times, symptoms may be nonspecific, such as irritability and crying. Other times, the presentation is asymptomatic.
ETIOLOGY AND PATHOPHYSIOLOGY
Most common FBs in children include5:
Inanimate objects such as beads (see Figure 30-1), cotton tips, paper, toy parts, crayons (Figure 30-2), eraser tips, food, or organic matter, including sand (Figure 30-3), sticks, and stones.
Insects (Figure 30-4).
Pathogenesis includes some of the key elements of otitis externa (see Chapter 29, Acute Otitis Externa):
Initial breakdown of the skin-cerumen barrier (caused by presence of FB)
Skin inflammation and edema leading to subsequent obstruction of adnexal structures (e.g., cerumen glands, sebaceous glands, and hair follicles)
FB reaction leading to further skin injury
In the case of alkaline battery electrochemical reaction, severe alkaline burns can occur
Piece of a crayon in the ear canal of a 4-year-old boy. (Reproduced with permission from William Clark, MD.)
Beach sand granules with exostosis in the ear of a cold water surfer. The exostoses are common in cold water swimmers and surfers. (Reproduced with permission from Roy F. Sullivan, PhD. Audiology Forum: Video Otoscopy, www.rcsullivan.com.)
Ant in the ear canal. (Reproduced with permission from Vladimir Zlinsky, MD in Roy F. Sullivan, PhD. Audiology Forum: Video Otoscopy, www.rcsullivan.com.)