Experience Summary

In this 360-degree video, observe the microscope assessment and management of a patient with an ear foreign body.

Clinical Context

The removal of a foreign body from the ear is a common procedure encountered in primary care, emergency departments, and otolaryngology clinics, especially in children. Young children frequently insert objects such as beads, small toys, food items, paper, or cotton buds into the external auditory canal (EAC) out of curiosity. In adults, foreign bodies may result from accidents, trauma, or misplaced hearing aid components.

Patients typically present with symptoms such as ear discomfort, hearing loss, a feeling of fullness, or visible foreign material. In some cases, ear discharge, bleeding, pain, or infection may be present, particularly if the foreign body is organic, sharp, or has been present for an extended period. Insects within the ear canal can cause significant distress and pain.

Prompt removal of the foreign body is essential to avoid complications such as ear canal trauma, tympanic membrane perforation, infection, or, in rare cases, hearing damage. The method of removal depends on the type, size, location of the object, and the level of cooperation from the patient.

Common removal techniques include the use of hooks, forceps, suction, or irrigation, provided the tympanic membrane is intact and the object is suitable for this approach. In cases where the object is close to the eardrum, deeply embedded, or previous removal attempts have failed, referral to an ENT specialist is often required. In young or uncooperative children, removal under general anaesthesia may be necessary to ensure safety and reduce distress.

Key Points for Clinicians to Discuss with Parents Before the Procedure

1. Nature of the Problem: Explain what a foreign body in the ear is, what object is suspected or confirmed, and how it may be causing symptoms such as discomfort, hearing loss, or infection.
2. The Planned Procedure: Describe how the foreign body will be removed, including the use of instruments such as forceps, hooks, or suction under direct vision with an otoscope or microscope.
3. Possible Need for Sedation or Anaesthesia: Discuss that if the child is very young, anxious, or uncooperative, the procedure may need to be performed under general anaesthesia to ensure safety and minimise trauma.
4. Potential Risks and Complications: Explain possible risks, including minor trauma to the ear canal, bleeding, discomfort, incomplete removal, or very rarely, perforation of the eardrum.
5. Benefits of Removal: Reassure parents that timely removal reduces the risk of infection, prevents further complications, and restores ear comfort and hearing.
6. Post-Procedure Care: Inform parents about what to expect after the procedure, including possible mild discomfort and signs to watch for, such as ongoing pain, discharge, or hearing issues, which would require follow-up.
7. Opportunity for Questions: Allow parents to ask questions and ensure they understand and consent to the proposed procedure.

Learning Outcomes

1. Observe the use of a microscope for ear examination.
2. Learn how to counsel a family of a child with an ear foreign body.
3. Understand the equipment required for the removal of an ear foreign body.

External Resources

• Nasal anatomy
• Larynx anatomy