Foreign Body – August 15, 2024
An 8-year-old presented to the emergency department (ED) for a foreign body in her ear. The child states she placed an “orbeez” water bead in her ear while she was visiting her family four days prior. She spent the weekend swimming and being otherwise active. When she returned home, the child told her mother about the foreign body who attempted to remove it without success. She was not complaining of any pain, but her hearing was muffled. In the ED, she was a talkative and obviously curious child. Her Wispr digital otoscope exam is shown.
This child presented for an ear foreign body that was successfully and painlessly removed with a small suction catheter, facilitated by direct visualization with the Wispr digital otoscope. The video removal of the bead is shown below.
Water beads are tiny soft polymer spheres that expand massively when placed in liquids. Pediatric complications related to ingestion or placement in the external auditory canal (EAC) are common and have been implicated in serious injury. Tragically, there have been two reported deaths following ingestion in toddlers. When dry, these beads are only several millimeters in diameter and thus can be easily ingested or placed into the ear canal. However, shortly after becoming moist or immersed in liquid, they begin to expand and may reach 100x the initial diameter.
The child in this case is fortunate to have had such an uneventful foreign body retrieval. In a 2023 case series of seven children presenting with water beads in the ear, six required removal under general anesthesia with three needing additional surgical intervention to restore hearing deficits. In the most severe case, the bead had been present for months, undetected despite multiple visits to the ED for drainage, pain, and decreased hearing. This case is a reminder that children can and will put anything that fits into their ear, nose, and mouth–early recognition and management are important, particularly when water beads are suspected!
Children are well-known for placing foreign bodies in their ears. Examples include tic tacs, pencils, beads, and beans.
WiscMed thanks Dr. Michael Kim of the University of Wisconsin – Madison BerbeeWalsh Department of Emergency Medicine for this week’s interesting case.
Here is the complete video.
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