External Auditory Canal Foreign Bodies

A common problem seen in family physicians' offices is a patient with an external auditory canal foreign body. A wide variety of objects can be found. In one study of 191 patients with aural foreign bodies, 27 different objects were discovered (Ansley and Cunningham, 1998). The most common were beads, plastic toys, pebbles, insects (especially cockroaches), popcorn kernels, earrings, paper, peas, cotton, pencil erasers, and seeds. When a patient presents with a chronic dry cough that has not responded to the usual measures, the physician should look for an aural foreign body (causing irritation of the ninth cranial nerve).

Removal of an external auditory canal foreign body is simplified if the object is in the lateral one third of the external auditory canal. Objects within the medial two-thirds pose a greater challenge. A variety of instruments can be used, depending on the object, including cerumen loops, alligator forceps, and otologic-tip suctions. Irrigation with body-temperature sterile water often dislodges the object. Hygroscopic objects such as vegetables, beans, and other food matter can swell and make the object even more impacted and should not be irrigated. Disk batteries should be removed immediately because of the possibility of liquefaction necrosis of the external auditory canal. Aural irrigation is contraindicated because wetting of the battery leads to leakage of electrolyte solution.

Smooth, round objects pose a difficult problem because, in trying to remove them, they are often pushed farther into the canal. Aural irrigation or even cyanoacrylate glue on the tip of a straightened paper clip is effective in removing objects that are difficult to retrieve. Methods to remove cockroaches or other insects include microscope immersion oil, mineral oil, or lidocaine. The effect of mineral oil or microscope immersion oil is to drown the insect, whereas lidocaine tends to make cockroaches crawl rapidly out of the canal (Bressler and Shelton, 1993). Otomicroscopy is often required for safe removal.

Depending on their age, fewer than 35% of patients should require anesthesia. The younger the patient, the more likely anesthesia will be required. Objects with sharp edges are best removed with an operating microscope with the patient under general anesthesia. Complications of foreign body removal include canal wall trauma and tympanic membrane perforation. Immobilization of the patient is the key to successful removal of aural foreign bodies, and at least two assistants are necessary.

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