Mineral oil is also an alternative to viscous lidocaine.Ī small amount of viscous lidocaine can be a helpful local anesthetic.
This can be prevented by using a syringe and angiocatheter to fill the ear canal with viscous lidocaine and allowing it to sit for 15 minutes prior to removal. However, live bugs often cause significant patient discomfort with attempted removal. It works best for smaller metal objects and those in the more distal portion of the ear canal.Ĭan be manually extracted with forceps or a curette, or irrigated out of the ear canal as previously described. Tip: Best used to extract round objects which are well visualized.Ĭan be used for removing metal foreign bodies. Be very cautious as glue can be accidentally applied to the ear canal or TM itself and cause tissue damage. Tip: Best for hard, round foreign bodies.Ĭan be placed on the end of a cotton-tipped applicator that is advanced into the ear canal and pressed against the foreign body until dry. The side port can be occluded to capture the object and pull it out. Suction tpically requires 100 mmHg or more of negative pressure with a soft-tipped plastic suction catheter placed against the object. Irrigation should also never be used if the foreign body is a button battery. This will cause further difficulty with extraction. This method should not be used for foreign bodies made of organic material as they will soak up the fluid and expand. However, irrigation should not be used in patients with a history of TM perforation or instrumentation including myringotomy tubes. This technique can be helpful for a variety of foreign body shapes and sizes and is safe for normal TMs. A plastic basin may be used to catch the fluid. They are more effective for soft or irregularly shaped objects that can be grasped firmly to prevent pushing them further out of reach.Ĭan be done using a 20 mL syringe and 16 gauge angiocatheter filled with water or normal saline. Forceps can also be used to directly grasp objects but are less effective when used for round objects or larger objects. Some include those with removable lenses and operating otoscopes that allow tools to pass through the otoscope head while directly visualizing foreign bodies.Ĭurettes are best for foreign bodies that can be well visualized but are small enough that the curette can be pushed beyond the object and pulled from behind. There are several different types of otoscopes.These techniques can also push the object further back in the ear canal and make removal even more difficult. Side effects of these removal techniques include tissue damage such as abrasions, lacerations or TM perforations.Additionally, sharp objects should not be used if the patient is not cooperative with your exam so that accidental TM damage can be avoided. In general, you should avoid sharp instruments if you are not getting adequate visualization of the foreign body.If this is present, the patient should not undergo removal in the ED and should be referred to otolaryngology (ENT) for removal. You should always check for tympanic membrane (TM) perforation.There is a wide array of tools available to assist in removal and this can often be confusing for providers as these tools are not created equal for all types or locations of foreign bodies. While foreign bodies in children often include a wide range of objects such as toys, rocks, beads, crayons, and cotton swabs, foreign bodies in adults are most commonly insects.
KATZ EXTRACTOR PRO
Here are a few tips to help you remove those foreign bodies like a pro and get your patient safely on his or her way. In addition, it can be challenging when trying to determine if a patient will be cooperative and whether analgesia or sedation will be required. With all the possible tools and techniques for foreign body removal, choosing a method that is most likely to be successful for your patient can sometimes be a daunting task. And just then, a 2-year-old boy is brought in to the ED by his parents because he had just swallowed a coin. In the next room, a 3-year old girl presents with her mother after having placed a plastic bead in her left nostril. It is a busy day in the emergency department (ED) when a 35-year old male presents with an insect in his right ear. Authors: Brooke Moungey, MD (Senior EM Resident at the University of Wisconsin) and Christopher Stahmer, MD (Clinical Assistant Professor at the University of Wisconsin) // Edited by: Jennifer Robertson, MD, MSEd and Alex Koyfman, MD EM Attending Physician, UTSW Medical Center / Parkland Memorial Hospital)
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