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Retained foreign bodies (FBs) are responsible for approximately 11% of otolaryngologic emergencies and most frequently involve the ear and nose.1 They can occur at all ages, but the majority of cases occur in children <8 years of age.1–4 The objects typically come from the immediate environment of the child. In North America, they most commonly include toys, beads, insects, cotton, crayon fragments, button batteries, and paper, as well as a wide range of unusual objects including play slime, fish hooks, and toothpicks.2–8

Ear and nose FBs are commonly asymptomatic and are identified based on a verbal report by the child or a witnessed event.8 Ear FBs can also present with pain, bleeding, discharge, tinnitus, or fever. Nasal FBs can present with local pain or discomfort, nosebleeds, odor, or discharge.4,9

Most FBs in the ear canal can be removed in the ED without otolaryngologist consultation.3,8 Successful removal is influenced by the type and depth of FB present, its visibility, patient cooperation, and the number of previous failed removal attempts4,7,10,11 (Table 143A-1). Removal can be enhanced by the use of an otomicroscope, which is easy to learn to use and provides magnification and improved hands-free viewing (Figure 143A-1).10 Sedation may be necessary for adequate patient comfort and cooperation, and may increase the chance of removal.8 Consider sedation when the patient is agitated or when previous removal attempts in an unsedated patient have failed. FB removal under deep seadation or general anesthesia is recommended when the FB has been in place for a long period, or is not visible or when the child is uncooperative or mentally handicapped. IV ketamine is an excellent choice for deep sedation in the ED (see Chapter 39, Pain Management in Infants and Children).5,8

Table 143A-1 ED Pediatric Ear and Nose Foreign-Body (FB) Removal

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