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Pediatric ear foreign body retrieval: A comparison across specialties
Katie Mingo1, David Eleff2, Samantha Anne1
1Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic Foundation 9500 Euclid Ave, Cleveland, OH 44195, USA.
American Journal of Otolaryngology
|August 14, 2019
Summary
Pediatric ear foreign bodies are common. Early consultation with otolaryngology (ENT) is recommended for difficult-to-grasp objects, especially in young children, to improve removal success and reduce complications.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Emergency Medicine
Background:
- Foreign bodies in the ear are a frequent occurrence in pediatric patients.
- Initial management often occurs in primary care or emergency departments, with varying success rates.
Purpose of the Study:
- To identify patient and foreign body characteristics that warrant referral to otolaryngology for pediatric ear foreign bodies.
- To optimize successful foreign body removal and minimize associated complications.
Main Methods:
- Retrospective chart review of 275 pediatric patients (aged 1-18) presenting with ear foreign bodies between January and December 2016.
- Data analyzed included removal success, complication rates (major/minor), sedation use, antibiotic use, patient age, behavioral disorders, and foreign body characteristics.
- Exclusion criteria included retained or extruded tympanostomy tubes.
Main Results:
- Otolaryngology (ENT) achieved a significantly higher successful removal rate (95.4%) compared to primary care physicians (75.0%) or ENT after prior failed attempts (65.8%).
- Removal in the emergency department (ED) showed comparable success rates (85.7%) to initial ENT consultation.
- Repeated removal attempts, particularly by ENT after prior failures, were associated with the highest rate of minor complications (26.3%) and increased operative intervention (34.2% vs. 4.6% for initial ENT referral).
- Younger age (≤5 years) and difficult-to-grasp foreign bodies (e.g., beads, stones) increased complication and operative intervention rates when prior removal attempts had failed.
Conclusions:
- Early referral to otolaryngology for pediatric ear foreign bodies is crucial for maximizing successful removal.
- Repeated removal attempts are linked to increased minor complications and the need for operative intervention.
- Consider early otolaryngology consultation for foreign bodies that are difficult to grasp or in patients aged five years or younger to prevent adverse outcomes.
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