|Year : 2013 | Volume
| Issue : 3 | Page : 149-151
An unusual foreign body in ear
Mukta Pagrani, Chander Mohan
Department of Ear, Nose, Throat, and Head and Neck Surgery, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
|Date of Web Publication||2-Sep-2013|
Department of Ear, Nose, Throat, and Head and Neck Surgery, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Foreign bodies in external auditory canal in pediatric age group are quite often encountered by otolaryngologists in emergency as well as in outpatient. We report here a case of asymptomatic unnoticed unusual foreign body in external auditory canal which was removed by post-aural approach in a child admitted in the pediatric surgery ward of the hospital.
Keywords: External auditory canal, Foreign body, Post-aural incision
|How to cite this article:|
Pagrani M, Mohan C. An unusual foreign body in ear. Indian J Otol 2013;19:149-51
| Introduction|| |
Foreign bodies in the external ear are most frequent in otolaryngological practice. , A large variety of foreign bodies may be encountered in the external auditory meatus. The objects may be organic or inorganic. Common foreign bodies include paper, cotton wool, rubber, seeds, beads, ball bearings, stones, and crayons. Foreign bodies are inserted into the ear more commonly by children than adults.  There are other clinical features apart from otitis externa attributable to a foreign body in the external meatus such as deafness, tinnitus, and otalgia.  The most common complications of a foreign body in the ear are bleeding and otitis externa.  Even an attempt at removal can cause iatrogenic complications like canal laceration, bleeding, infection, and perforation of tympanic membrane. 
An unusual case of a child with a needle in the ear canal is reported which had been pushed into the post-auricular region. The parents of the child were unaware of the mode of entry of foreign body in the ear canal and this was detected accidently by the attending doctors.
| Case Report|| |
An 18-month-old male child was referred to ENT department from pediatric surgery department with complaint of an asymptomatic pin like metallic foreign body in the left external auditory canal. The child was a case of sub-acute intestinal obstruction and the foreign body was accidently noticed by attending doctors.
On examination a metallic pin like foreign body was seen lying in the external auditory canal wedged between the anterior and posterior canal walls [Figure 1]. There was no swelling, bleeding, or discharge in the canal. There was no scar mark, skin discoloration, swelling, or tenderness in the pre-auricular and post-auricular region. The foreign body was embedded between the walls and did not move when attempt was made to remove it.
|Figure 1: Metallic pin-like foreign body in the left external auditory canal|
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Skigram lateral view mastoid showed a fine radiopaque foreign body extending from the mastoid region up to the external auditory canal [Figure 2]. All the investigations for surgery under general anesthesia were within normal limits.
|Figure 2: Skigram showing radiopaque foreign body in region of mastoid and external auditory canal (left ear)|
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Foreign body removal was planned under general anesthesia. It was tried to disimpact and remove the foreign body through transcanal approach, but it was difficult to dislodge the foreign body. The foreign body was pushed posteriorly, it produced a projection underneath the intact skin. An incision was made in post-aural area over the projection [Figure 3]. The anterior end was dislodged and the foreign body was pulled out. It was the metallic portion of the hypodermic needle without the plastic hub, 2.4 cm in length [Figure 4]. The external auditory canal and tympanic membrane were normal. Post-operative period was uneventful.
| Discussion|| |
Foreign bodies in external ear are frequently seen in emergency services. Several reasons lead to this intercurrence like accidental entry of objects, the children's curiosity, games, attempt to local hygiene, and itch, etc. 
Removal of a foreign body in the external auditory canal requires expertise. Many authors found that removal by non-ENT personnel is significantly associated with complications and emphasize that difficult or all cases should be managed by an otolaryngologist.  Success at removal depends on the type of foreign body, the co-operation of the patient, the type of instrument used, and the experience and skills of the physician. 
In a series of 711 cases of foreign bodies in the external auditory canal in children, Endican et al., reported a case (0.1%), where a seed was pushed into the middle ear through pre-existing perforation of the eardrum during attempted removal in a clinic. 
Fornazeri et al., in review of 462 cases of foreign bodies in ear found 40.5% patients were above 16 years of age and 50.27% foreign bodies were insects. Attempt at removal resulted in tympanic membrane perforation in 33 cases. 
In a study by Ogunleye et al., most of the patients with otic foreign bodies were found to be between 1 and 16 years with an average age of 6 years. Two cases with beads in the ear presented very late (after 6 months and 4 years, respectively). Thus some foreign bodies may remain in external ear canal unnoticed for a long period before presenting or discovery. 
Shafi et al., in a review of 653 cases of foreign bodies of external auditory canal found 97.5% of foreign bodies to be single, out of which only 1.8% were metallic. Complication rate on removal was 0.6% in the form of perforation of tympanic membrane. Seventy-seven percent of foreign bodies were removed under general anesthesia. Duration of retained foreign body was unclear in 227 (43.8%) patients as patients were unaware of presence of foreign body. 
Davis et al., reported topically applied local anesthetic tends to have a partial effect at best, and although a "four quadrant block" has been described, even this may not produce complete anesthesia, particularly of the tympanic membrane.  Local anesthetic will do little for compliance in the pediatric population. For this reason a general anesthetic is to be preferred where the patient is uncooperative or removal of a foreign body proves difficult. 
Singh et al., reported the high complication rate for foreign body removal without general anesthesia. An unsuccessful attempt to remove a foreign body may cause further trauma and complications. 
| Conclusions|| |
Removal of foreign bodies from the external auditory canal is an essential skill and casual removal may lead to impaction of foreign body and complications. Foreign body removal from external auditory canal especially in children should preferably be removed with proper instruments under general anesthesia, good illumination, and magnification if required. Since retained foreign body may go unnoticed in children for a long time, the ears and nose should be carefully examined in every child attending the ENT services.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]