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Comparison of Care Settings for Pediatric External Auditory Canal Foreign Bodies: A Meta-Analysis
Ana C White1,2, Michael C Shih1,3, Shaun A Nguyen1
1Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Insights
Pediatric ear foreign body removal success rates vary by provider. Otolaryngologists (ENTs) achieve the highest success without prior attempts, while Emergency Departments (EDs) have the lowest. Previous removal attempts decrease ENT success.
Area of Science:
- Pediatric Otolaryngology
- Emergency Medicine
- Primary Care
Background:
- Pediatric external auditory canal foreign bodies (EAC FBs) are common, requiring effective removal strategies.
- Success and complication rates of EAC FB removal can differ based on the healthcare setting.
Approach:
- A meta-analysis synthesized data from 13 studies involving 3891 pediatric patients undergoing EAC FB removal.
- Success rates and complications were stratified by healthcare setting: Emergency Departments (EDs), Primary Care Providers (PCPs), and Otolaryngologists (ENTs).
Key Points:
- Otolaryngologists (ENTs) achieved the highest success rate (92.9%) for pediatric EAC FB removal when no prior attempts were made.
- Emergency Departments (EDs) demonstrated the lowest success rates (64.0%).
- Prior removal attempts by other providers significantly decreased success rates for ENTs (64.1%).
Conclusions:
- Previous EAC FB removal attempts by non-ENTs negatively impact subsequent removal success by ENTs, likely due to increased patient non-cooperation or procedural complications.
- Healthcare institutions should identify factors leading to EAC FB removal failure and facilitate timely ENT referral.
- Enhanced communication and collaboration between EDs, PCPs, and ENTs are crucial for optimizing outcomes in pediatric EAC FB management.
Objective:
To compare the success and complication rates of pediatric external auditory canal foreign body (EAC FB) removal between Emergency Departments (ED), Primary Care Providers (PCP), and Otolaryngologists (ENT).
Methods:
PubMed, Scopus, and Embase were searched through January 13, 2022. Studies mentioning EAC FB removal success rates and types of healthcare settings were included. Pooled measures included abrasions/lacerations, TM perforations, and success rate stratified by healthcare setting.
Results:
Thirteen studies and 3891 patients were included in the meta-analysis. Most comparisons between EAC FB removal success rates for EDs versus PCPs versus ENTs were statistically significant. The highest FB removal success rate was in patients who presented to ENTs without previous removal attempts (92.9% [95% CI 84.6-98.2]). EDs had the lowest success rates (64.0% [95% CI 48.3-78.3]). For patients that had a previous attempt at FB removal, ENTs had a success rate of 64.1% [95% CI 42.0-83.5].
Conclusions:
For ENTs treating pediatric EAC FB, removal success rates decrease if a different healthcare provider previously attempted EAC FB removal. This effect likely is due to decreased patient cooperativeness or increased FB complications (eg, canal edema and bleeding limiting visualization) after previous removal attempts. Individual institutions should identify conditions that increase EAC FB removal failure rates and necessitate ENT referral. Therefore, the communication and concerted efforts between EDs, PCPs, and ENTs are critical for the improved outcomes of pediatric EAC FBs.
