18 m/o with ear pain
Patient will present as → an 18-month-old with ear pain and otorrhea. Otoscopic examination reveals a small insect impacted in the ear canal which is still moving. The tympanic membrane appears intact.
Irrigation of the external ear can be uncomfortable for the child. Aggressive flushing can cause perforation of the tympanic membrane, so caution is advised while irrigating
- After each flush, it is prudent to recheck the external canal for retained foreign body (FB) fragments, which can occur with an insect
- After irrigation, if the child is uncomfortable, consider treating with topical pain agents such as benzocaine-anti-pyrene
- Insects must be immobilized prior to removal. Drown insects with mineral oil or viscous lidocaine before attempting removal
Diagnosis is made by history and physical exam with visualization of foreign body
Removal of foreign body which requires direct visualization prior to removal either via warm irrigation with syringe, or instruments like an alligator forceps
- Insects must be immobilized prior to removal. Drown insects with mineral oil or viscous lidocaine before attempting removal
Question 1 |
A 4 year-old boy presents with pain and irritation of his left ear. Otoscopic examination reveals an insect in the left auditory canal. The tympanic membrane is not completely visualized. Which of the following is the most appropriate management of this patient?
Debrox insertion with suction removal Hint: Debrox is used for cerumen impaction not foreign body removal. | |
Irrigation with room temperature saline Hint: Irrigation with room temperature saline is useful for small particle removal only if the tympanic membrane is well-visualized and without perforation. It is not indicated in the removal of an insect. | |
Insertion of 2% lidocaine solution with suction or forceps removal | |
Polymyxin drop insertion via wick Hint: Polymyxin B is indicated in otitis externa and administered via a wick when there is significant edema of the auditory canal. It is not indicated in the removal of a foreign body. |
Question 1 Explanation:
Two percent lidocaine solution will paralyze the insect and provide topical anesthesia for suction or forceps removal.
There is 1 question to complete.
