Foreign bodies are commonly found in the external auditory canal (EAC) of children and sometimes in adults.1 Children commonly place small objects such as food (e.g., beans, peas, corn, and seeds) or small round objects (e.g., beads, rocks, and toys) in the EAC.2-6 Adults are more likely to suffer from items used to clean or scratch the ear (e.g., cotton swab, paper, paper clips, and pencil lead) and insects that crawl into the ear.4,6 The EAC and tympanic membrane (TM) are exquisitely sensitive and delicate.3,7 Foreign bodies in the EAC are extremely irritating to patients, especially live insects that scratch the TM trying to escape. Injuries can occur unless proper care is taken in the removal of EAC foreign bodies.
ANATOMY AND PATHOPHYSIOLOGY
The EAC is an S-shaped structure that extends from the auricle to the TM and is approximately 2.5 cm long in adults.8,9 The lateral or distal third is cartilaginous with thick skin. It has more hair follicles, glands, and subcutaneous tissue than the medial or proximal two-thirds of the EAC. The medial EAC is bony with a thinner and more fragile layer of skin.8-11 The narrowed isthmus of the EAC is located between the cartilaginous and bony portions.2,8 The EAC ends medially at the TM. The TM is angled obliquely to increase the surface area for carrying sound energy to the middle ear.10 The anteroinferior EAC is 0.6 mm longer than the posterosuperior portion.8 Auriculotemporal branches of cranial nerves V, VII, IX, and X and the greater auricular nerve of the cervical plexus supply sensation to the EAC.8 The EAC and TM have separate innervation. Indications for anesthetizing these areas are distinct from those for performing an auricular block (Chapter 156). The posterior auricular, superficial temporal, and deep auricular arteries provide the blood supply to the external ear. The posterior auricular and superficial temporal veins drain the EAC. The posterior auricular vein can connect to the sigmoid sinus and provide a route for spread of infection between the ear and the intracranial cavity.9
All EAC foreign bodies must be removed. The questions are how quickly this must be done, who should do it, and which is the safest technique. The method used is individualized to the patient, type of foreign body, Emergency Physician preference and experience, and the availability of an Otolaryngologist. The most urgent indication for immediate removal is an alkaline button battery because of the extensive and severe damage it may cause in a very short time.1,12
Some foreign bodies are very easily and safely removed with the equipment available in any Emergency Department. Other foreign bodies may require removal under general anesthesia by an Otolaryngologist. Remove foreign bodies that are in the lateral half ...