Foreign Body – Tic-Tac
A 10-year-old boy with mild autism presented to the emergency department (ED) with concern for a foreign body in his ear. As he walked past the physician computer stations, he was heard saying “I don’t know how they are going to get it out. It’s really far in there.” Upon evaluation, the child reported that he placed a tic tac in his right ear approximately an hour prior to arrival. His mother attempted to flush the ear with water, but this was unsuccessful in removing the object. Wispr otoscopic exam demonstrated that the child was correct in his assessment that the tic tac was indeed very deep in the external auditory canal (EAC).
Whether placed intentionally by a young child or as a consequence of sharing the earth with insects or because we listen to music, ear foreign body (FB) is a common chief complaint. Fortunately, successful removal can be facilitated by an understanding of the EAC anatomy, attention to patient comfort, and a steady hand.
The EAC is much more than a simple conduit connecting the outer ear from deeper structures. As a highly innervated channel that funnels sound waves and protects delicate middle ear tissues, the EAC anatomy can make visualization and retrieval of FBs challenging. Two such considerations encountered in this patient include canal orientation and anatomic narrowing.
Initial examination revealed the FB to seem anterior with the curvature of the canal partially obscuring the tic-tac. This curvature was easily straightened with gentle upward and posterior traction on the external ear and greatly minimized (but did not eliminate) the obstructing view. The tic-tac was still not completely visualized due to another normal attribute of the EAC-narrowing of the canal near the cartilaginous-osseous junction that becomes the frequent site of FB entrapment. Occasionally unsuccessful attempts at removal (or small fingers) may push the object past this junction and deeper into the canal, making retrieval even more difficult. This is likely to have been the case with our patient as the oblong tic tac appears to have been pushed inward, allowing it to rotate nearly vertical once past the narrowing. This orientation foiled initial attempts using the cyanoacrylate (super glue) technique as the force required to remove past the narrowing was too great. Fortunately, the child was remarkably compliant and ultimately tolerated removal with a micro-forceps borrowed from the ED’s plastic surgery tray. Following removal, he happily requested a picture of the tic tac to show his friends.
Here is the complete Wispr otoscope video of the exam:
Complete exam video
