Iatrogenic ossicular injury in an autistic child

Area of Science:

• Otolaryngology
• Pediatric Medicine
• Neurodevelopmental Disorders

Background:

• Foreign body insertion in the ear canal is a common pediatric issue.
• Autism Spectrum Disorder (ASD) presents unique challenges in managing pediatric medical emergencies.
• The safe removal of foreign bodies requires careful consideration of the patient's age and temperament.

Observation:

• A 5-year-old autistic child presented with an oiled popcorn kernel lodged in the right ear canal.
• Attempted manual removal in an emergency setting without anesthesia led to significant trauma.
• The child required forceful restraint during the removal procedure.

Findings:

• The forcible removal resulted in severe ossicular injury, damaging the small bones of the middle ear.
• This case highlights the heightened risk of iatrogenic injury when removing ear foreign bodies from uncooperative children.
• The severity of ossicular injury can be substantial in such scenarios.

Implications:

• Anesthesia is strongly recommended for foreign body removal in young children, particularly those with autism.
• Healthcare providers must recognize the increased risks associated with managing autistic children in emergency situations.
• Prompt and appropriate management, including sedation or anesthesia, is vital to prevent severe complications like ossicular damage.