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Foreign Bodies in the Ear, Nose, and Airway

Foreign bodies in the ear, nose, and breathing tract (airway) sometimes occur in children. Foreign bodies refer to any object that is placed in the ear, nose, or mouth that is not meant to be there and could cause harm without immediate medical attention.

Foreign bodies in the ear:

Foreign bodies can either be in the ear lobe or in the ear canal. Objects usually found in the ear lobe are earrings, either stuck in the lobe from infection or placed too deep during insertion. Foreign bodies in the ear canal can be anything a child can push into his/her ear. Some of the items that are commonly found in the ear canal include the following:

food insects toys buttons pieces of crayon small batteries

It is important for parents to be aware that children may cause themselves or other children great harm by placing objects in the ear. The reason children place things in their ears is usually because they are bored, curious, or copying other children. Sometimes, one child may put an object in another child's ear during play. Insects may also fly into the ear canal, causing potential harm. It has also been noted that children with chronic outer ear infections tend to place things in their ears more often.

What are the symptoms of foreign bodies in the ear?

Some objects placed in the ear may not cause symptoms, while other objects, such as food and insects, may cause pain in the ear, redness, or drainage. Hearing may be affected if the object is blocking the ear canal.

Treatment for foreign bodies in the ear:

The treatment for foreign bodies in the ear is prompt removal of the object by your child's physician. The following are some of the techniques that may be used by your child's physician to remove the object from the ear canal:

instruments may be inserted in the ear magnets are sometimes used if the object is metal

cleaning the ear canal with water a machine with suction to help pull the object out

After removal of the object, your child's physician will then re-examine the ear to determine if there has been any injury to the ear canal. Antibiotic drops for the ear may be prescribed to treat any possible infections.

Foreign bodies in the nose:

Objects that are put into the child's nose are usually soft things. These would include, but are not limited to, tissue, clay, and pieces of toys, or erasers. Sometimes, a foreign body may enter the nose while the child is trying to smell the object. Children often place objects in their noses because they are bored, curious, or copying other children.

What are the symptoms of foreign bodies in the nose?

The most common symptom of a foreign body in the nose is nasal drainage. The drainage appears only on the side of the nose with the object and often has a bad odor. In some cases, the child may also have a bloody nose.

Treatment for foreign bodies in the nose:

Treatment of a foreign body in the nose involves prompt removal of the object by your child's physician. Sedating the child is sometimes necessary in order to remove the object successfully. This may have to be performed in the hospital, depending on the extent of the problem and the cooperation of the child. The following are some of the techniques that may be used by your child's physician to remove the object from the nose:

suction machines with tubes attached instruments may be inserted in the ear

After removal of the object, your child's physician may prescribe nose drops or antibiotic ointments to treat any possible infections.

Foreign bodies in the airway:

Foreign bodies in the airway constitute a medical emergency and require immediate attention. The foreign body can get stuck in many different places within the airway. Foreign bodies in the airway account for nearly 9 percent of all home accidental deaths in children under 5 years of age. As with other foreign body problems, children tend to put things into their mouths when they are bored or curious. The child may then inhale deeply and the object may become lodged in the "airway" tube (trachea) instead of

the "eating" tube (esophagus). Food may be the cause of obstruction in children who do not have a full set of teeth to chew completely, or those children who simply do not chew their food well. Children also do not have complete coordination of the mouth and tongue which may also lead to problems. Children between the ages of 7 months and 4 years are in the greatest danger of choking on small objects, including, but not limited to, the following:

seeds toy parts grapes hot dogs pebbles nuts buttons

Children need to be watched very closely to avoid a choking emergency.

What are the symptoms of foreign bodies in the airway?

Foreign body ingestion requires immediate medical attention. The following are the most common symptoms that may indicate a child is choking. However, each child may experience symptoms differently. Symptoms may include:

choking or gagging when the object is first inhaled coughing at first wheezing (a whistling sound, usually made when the child breathes out)

Although the initial symptoms listed above may subside, the foreign body may still be obstructing the airway. The following symptoms may indicate that the foreign body is still causing an airway obstruction:

stridor (a high pitched sound usually heard when the child breathes) cough that gets worse child is unable to speak pain in the throat area or chest hoarse voice blueness around the lips not breathing the child may become unconscious

Treatment for foreign bodies in the airway:

Treatment of the problem varies with the degree of airway blockage. If the object is completely blocking the airway, the child will be unable to breath or talk and his/her lips will become blue. This is a medical emergency and you should seek emergency medical care. Sometimes, surgery is necessary to remove the object. Children that are still talking and breathing but show other symptoms also need to be evaluated by a physician immediately.
Objects or insects in ear overview
Foreign objects in the ear are common reasons for emergency room visits, especially in children. The majority of these foreign objects are harmless. Some are extremely uncomfortable (insects or sharp objects) and some can rapidly produce an infection (food or organic matter) requiring emergency treatment. If a person is not certain of the potential for harm in regard to an object or insect in the ear, seek medical care immediately.

What are causes of objects in the ear?

Most objects that get stuck in the ear canal are placed there by the person themselves. Children who are curious about their bodies and interesting objects, are the most common group who has this problem (children aged 9 months to 8 years). Beads, food (especially beans), paper, cotton swabs, rubber erasers, and small toys are the most common foreign bodies. Ear wax is a naturally occurring substance in the ear canal but can become a problem when it builds up to the point that it clogs the ear canal, and causes hearing loss or pain. Overuse of cotton swabs such as Q-tips to clean the ear can actually push wax and skin cell debris further into the canal and pack it against the eardrum causing symptoms. Insects can also fly or crawl into the ear canal. Usually this happens while sleeping on the floor or outdoors (for example, camping). This is often a frightening and dramatic event as the insect's buzzing and movement is very loud and sometimes painful. Structure of the Outer and Inner Ear Canal

What are the symptoms of an object in the ear?

The skin in the ear canal and the eardrum are very sensitive. Any inflammation or injury is usually readily apparent due to pain or irritation. In young children who are not old enough to verbalize their pain, the diagnosis can be challenging. Redness, swelling, or discharge (blood, inflammatory fluid, or pus) are the main signs of injury to the ear. Small children often scratch or rub the ear repeatedly. In the case of earwax impaction (cerumen impaction), a "fullness" or pressure is often reported and a decrease in hearing on the affected side is noticed. In extreme cases,dizziness, nausea and vomiting, or unsteady walking result from inflammation of the ear or build-up of pressure on the eardrum causing dysfunction of their middle ear.

When should I call the doctor for an object in the ear?

The vast majority of foreign bodies in the ear are not true medical emergencies. Call a doctor if something is in the affected person's ear, but the symptoms are minor. This can usually wait until the morning when your doctor's office opens if it occurs at night. If the affected individual has inflammation (swelling), fever, discharge, bleeding, or increasing pain; see a doctor urgently. If the object in the ear is a battery, seek medical attention immediately. If you are unsure of the severity of the injury, see a doctor. Certain foreign bodies are potentially more harmful than others. Organic material (bugs, plants, or food) should be removed promptly due to the possibility of swelling of the material and rapid onset of infection. Insects should be removed quickly as they cause distressing symptoms and great discomfort, and can sting or bite causing further damage. A few drops of mineral oil may be placed in the ear canal prior to going to the doctor to kill the insect and stop the buzzing or scraping sensation on the eardrum. Button-type batteries from household gadgets are particularly dangerous and need to be removed as soon as possible as they may leak chemicals that can burn and severely damage the ear canal even within an hour.

How is an object in the ear diagnosed?

Objects in the ear usually can be seen by a qualified medical professional by directly looking in the ear with an instrument called an otoscope. A magnifying light with a plastic cone tip is slid into the canal to look at the structures inside. In cases involving children, it is important to realize that there may be more than one foreign body, and other orifices (other ear, mouth, nose and rectum) may also need to be examined. Once the object is seen, there are many ways of retrieving it.

How is an object in the ear treated?

If the object is very small the affected individual can try to gently shake it out. Pulling the back of the ear (the pinna) gently toward the back of the head straightens out the ear canal and the foreign body may roll or slide out with a gentle shake of the ear. Do not strike the affected person's head on the opposite side to try to dislodge the foreign object. If the foreign object is deeper in the ear than be seen, a qualified medical professional should remove it. Do not stick anything into the ear to remove objects yourself, as you may push it in further and cause damage or rupture of the eardrum or scratch the skin of the ear canal. At the doctor's office or in the emergency room the foreign object can be removed using several techniques.

Modified tweezers or forceps can be used to reach in and grab the object with the help of an otoscope so important structures are not damaged. Gentle suction can be used to suck out the object. Irrigation of the canal with warm water and a small catheter can flush certain materials out of the canal and clean out debris. Some doctors have devised ingenious and novel ways to remove objects from ear canals (paper clips, magnets, glue, etc.)

Small children do not tolerate painful or scary interventions, and may need to be sedated medically to have objects removed from their ears. Often with children, the first try is the most successful, as subsequent attempts to remove an object can be painful and frightening to the child. Insects in the ear canal are often killed with either lidocaine (an anesthetic) or mineral oil. They are then flushed out with gentle warm water irrigation. After the foreign object is removed the doctor may put the patient on antibiotic drops for five days to a week to prevent infection from trauma to the ear canal.

What are some other types of ear emergencies?

Ruptured tympanic membrane(eardrum) can be a result of foreign bodies, middle ear infection, or pressure trauma to the ear. Often the patient feels pain, notices a thin bloody discharge from the ear, and has a decreased sense of hearing. If a person experiences these symptoms and think the eardrum may be ruptured or damaged seek medical care. Do not place cotton swabs, liquids, or other objects in ear. Acute otitis externa (swimmer's ear) is an infection of the outer ear canal that is usually caused by irritation of the canal skin that is made worse by water remaining in the canal after swimming or bathing. Cellulitis (skin infection) causes the ear canal to turn red and swell. The ear becomes very painful and a thin yellow fluid (infected pus) comes out of the canal. The infection can spread to the side of the face or the lymph glands in the neck. Treatment of swimmer's ear includes antibiotic drops and, in severe severe, antibiotics by IV or mouth. Ear wax impaction is usually a harmless cause of decreased hearing. Wax is formed in the ear canals naturally. Individuals who over-aggressively clean their ears with cotton swabs can push wax further into the canal, impacting (compressing) it against the ear drum. Over-the-counter (OTC) products, like carbamide peroxide (Auro, Debrox, Murine Earwax Drops) can be used to clean the ear regularly. If the wax impaction is causing pain, decreased hearing or dizziness, a doctor can irrigate (flush) the wax out of the ear gently with warm water and peroxide. If a person has chronic problems with ear wax buildup, they should discuss long-term solutions with an Ear, Nose, and Throat (ENT) specialist, also called an otolaryngologist.