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Foreign bodies in the ear are generally found in the external auditory canal and most often occur in children younger than 8 years of age. Toys (e.g., beads, marbles) are the predominant type of foreign body found in children, while cotton balls, jewelry, and insects are more common in adolescents and adults. Patients with a foreign body in the ear are often asymptomatic but may report symptoms such as a feeling of fullness in the ear, hearing loss, pruritus, otalgia, or discharge. Foreign bodies are diagnosed via otoscopy. Advanced imaging (CT/MRI) may be obtained if bony erosion, ossicular lesions, or other complications are suspected. Management consists of removal of the foreign body, with local anesthesia or procedural sedation as needed. In certain scenarios (e.g., tympanic membrane rupture, unsuccessful removal), specialist involvement may be required.
- Most often occurs in children < 8 years of age 
Epidemiological data refers to the US, unless otherwise specified.
- Children: mostly toys (e.g., beads, marbles), food 
- Adolescents and adults: cotton balls (e.g., from cotton swabs), jewelry (e.g., earrings), insects 
Patients are often asymptomatic, but they may present with nonspecific complaints (particularly children). 
- A feeling of fullness in the ear
- Hearing loss
- Otorrhea (hematic or purulent)
- Cough (due to the Arnold ear-cough reflex)
- Buzzing sound or sensation (if an insect is the foreign body)
A caregiver's report of an inserted object or nonspecific signs and symptoms may be the only features of ear foreign bodies in nonverbal or very young patients.
- Otoscopy 
- Advanced imaging (CT/MRI): Consider if bony erosion, ossicular lesions, or other complications are suspected. 
Especially in children, consider inspecting the other ear canal and both nostrils for additional foreign bodies. 
Foreign body removal 
Instrument-assisted manual removal and/or irrigation are typically attempted in the emergency department or other outpatient settings.
- Consider local anesthetic instillation or procedural sedation as needed.
- Document tympanic membrane perforation (if present) prior to attempting removal.
Removal techniques 
The appropriate removal technique for each patient will vary based on the type of foreign body and the patient's ability to tolerate the procedure.
Instrument-assisted manual removal
- Blunt right-angle hook or ear curette
- Balloon-tipped catheter (≤ 18 gauge)
- Cyanoacrylate-tipped applicator 
- Suction device
Removal may cause patient discomfort and/or minor bleeding.
- Insects: Kill or immobilize prior to attempting removal.
- Button batteries: Remove as soon as possible to avoid tissue necrosis and hemorrhage.
- Topical antibiotics (e.g., ofloxacin)
Consult ENT for the following: