Emergency Department and Primary Care Clinical Pathway for Evaluation/Treatment of Ear Foreign Body

Child with Suspected Foreign Body
in External Auditory Canal
  • Screening Questions
    • Pain, drainage, bleeding
    • Previous attempts
    • Concern for
      • Button battery
      • Penetrating injury
      • Living insect
      • Expandable object
  • KOPH Recommendations
  • Tx to PHL
    • Button battery
    • Rapidly expandable object (water beads)
    • Insect unable to be killed
    • Severe pain
    • Penetrating injury
  • Expedited ENT referral
    • Dead insect or non-expandable object
ED Triage
  • Avoid irrigation until full evaluation
  • Consider NPO, sedation needs
  • Screening questions
  • Notify Attending for suspected button battery
ED Team Assessment
  • History and Physical
  • Considerations for ENT Consultation
    • Suspected button battery
    • Penetrating injury
    • Deep object against tympanic membrane (TM)
    • Poor visualization
Procedure Preparation
  • Child Life
  • Anxiolysis, sedation as indicated
Button Battery
Expandable Object
Live Insect
Non-expandable Object
Avoid irrigation
  • Avoid irrigation
    • Expandable water beads
    • Foam
    • Organic matter
      • Vegetable
      • Popcorn kernel
  • Instill 1 of the following if no TM injury
    • Mineral oil
    • Lidocaine
    • Hydrogen peroxide
Immediate ENT Consult
Urgent Removal
Consider Removal
  • Shared decision making for expedited ENT referral or ED removal
  • Removal Procedure
  • Consider ENT Consult if sedation required
Foreign Body Successfully Removed
Foreign Body Not Removed
  • Re-examine ear canal, tympanic membrane
  • Topical antibiotics for TM trauma
  • Concern for tympanic membrane perforation
    • ENT Referral
    • Avoid submersion in water
Expedited ENT Referral
Posted: March 2024
Editors: Clinical Pathways Team