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Safety and Efficacy of a Protocol for In-Office Pediatric Aural Foreign Body Removal
Dilan Prasad1, Glenn Isaacson1
1Departments of Otolaryngology-Head & Neck Surgery, and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, USA.
Insights
A new protocol for removing pediatric ear foreign bodies (FB) in an office setting achieved a 96.4% success rate. This safe and effective method is ideal for children, including those with neurodevelopmental disorders.
Area of Science:
- Otolaryngology
- Pediatric Outpatient Care
Background:
- Pediatric aural foreign bodies (FB) are common.
- Office removal can be challenging, especially after prior failed attempts.
Purpose of the Study:
- To evaluate the safety and efficacy of a standardized office-based protocol for pediatric aural FB removal.
- To assess the success rate and complication profile of this approach.
Main Methods:
- Retrospective review of 447 pediatric cases over 22 years.
- Standardized protocol included shared decision-making, restraint, and microscope-guided removal.
- Failure defined as need for subsequent removal under anesthesia.
Main Results:
- 96.4% of FBs (431/447) were successfully removed in the office.
- Only 3.6% (16/447) required operating room removal.
- Two minor ear canal lacerations occurred; no severe complications were reported.
- Failed removals were more common in children with neurodevelopmental disorders (p=0.0001).
Conclusions:
- The described protocol is highly effective and safe for pediatric aural FB removal in an office setting.
- Successful removal rates remain high even for children with prior removal attempts or neurodevelopmental disorders.
- This approach is recommended for otolaryngologists managing pediatric patients.
Objectives:
To examine the safety and efficacy of a step-by-step protocol for the office removal of aural foreign bodies (FB) in a pediatric population.
Methods:
All children presenting to an academic pediatric outpatient department were identified from a computerized collection of office notes and operative reports. FB removal was performed in a standard fashion including: (1) pre-procedure discussion with shared decision making, (2) restraint in a supine position with a trained second person holding the head, (3) FB removal using an operative microscope and instrumentation. A case was considered a failure if subsequent removal under sedation or general anesthesia was required.
Results:
447 total cases (ears) were identified in 428 children (19 had bilateral FBs). 201/428 (47%) of children had previous attempts at FB removal elsewhere. 431/447 (96.4%) of FBs were successfully extracted in the office. 16/447 (3.6%) of FBs were removed in the operating room. Out of the 431 successful removals, two patients had minor complications (ear canal lacerations). No child suffered a more severe complication. The failed removal group was more likely to have a documented neurodevelopmental disorder (4/21 vs. 12/407, p = 0.0001).
Conclusion:
This protocol resulted in a high rate of successful FB removal, even in children with prior failed attempts. There were no significant ear injuries in this 22-year experience, which included children with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder. This approach should be considered by otolaryngologists who care for children in the office setting.
Level Of Evidence:
3-Retrospective review.
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