Foreign bodies in the ear and nose are most common in young children, who push in beads, food, toys or button batteries, while adults more often have insects or cotton swab tips. Most can be removed in the office, though button batteries and magnets are emergencies because they cause rapid tissue injury.
Key symptoms
- Often none, or a child says they put something in
- Ear: pain, fullness, reduced hearing or a buzzing insect
- Nose: one-sided foul-smelling discharge
- One-sided nosebleed or nasal blockage
What you find on exam
- Otoscope or nasal speculum with good light to identify the object
- Note its type: round, soft, organic, battery, insect
- Check the ear canal and eardrum for injury after removal
- Look in the other nostril and ear too
- Lungs: wheeze or reduced breath sounds if aspiration is possible
Tests
- Usually none when the object is seen and removed
- X-ray if a button battery or metal object is suspected and not seen
- Chest X-ray if aspiration is possible
Treatment basics
- Nose: positive pressure, such as the parent's kiss or blowing with the other nostril closed
- Instruments: alligator forceps, right-angle hook or suction, with the patient held still
- Ear irrigation with warm water only if the object is not organic or a battery and the eardrum is intact
- Kill a live insect with mineral oil or lidocaine before removal
- Refer to ENT if removal fails, the object is deep or there is injury
Red flags
- Button battery or magnets in the nose: emergency removal
- Breathing problems that suggest aspiration
- Eardrum injury, bleeding or vertigo after the object or a removal attempt
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.