7-year-old with Ear Pain

Foreign bodies (FB) are a frequent complaint in pediatrics, with the ear (40%) and nose (25%) accounting for most cases. Toddlers and preschoolers account for the highest prevalence of ear FB complaints—an unfortunate reality for any clinician hoping for a compliant patient. These curious youngsters are prone to placing a myriad of small objects such as beads, Tic Tacs, erasers, pencil tips, small toys, and popcorn kernels in their ears, often without disclosing such activity to a parent.  Such FBs may present with pain, itching, drainage, and bleeding, or may remain asymptomatic, found incidentally after an indeterminant duration.

Several factors impact the successful retrieval of an ear FB in the office or ED. Key among these are direct visualization, proximal location within the EAC, and a cooperative patient. Regardless of the tool utilized for removal, maximizing visualization and patient comfort is important to decrease the likelihood of traumatizing the EAC and tympanic membrane or pushing a proximal FB distally, where retrieval becomes nearly impossible without conscious sedation or operative intervention. A clinician generally has one chance in the clinic to remove the FB before the child becomes uncooperative and operating room sedation is required. This is why visualization and first-time removal success are so important.

In the present case, the FB was nicely visualized with the Wispr digital otoscope and felt to be accessible with a curved hemostat. The patient was positioned upright and distracted with the aid of a Child Life specialist.  A parent gently secured his head position, and the FB was removed without difficulty in a single attempt. Upon removal, the child and parent immediately recognized the FB as a broken Lite Bright piece—although how it got into his ear remained a mystery.

Here is a link to the various foreign bodies that have been discovered in an ear with the Wispr digital otoscope.

Here is the video of the foreign body removal.