Trick of the Trade: Ear foreign body removal with modified suction setup

2017-05-08T18:11:41+00:00

popcorn-kernelsA 5 year old boy comes in who has stuck a small unpopped popcorn kernel into each ear. My resident and I discuss  different methods to try to get it out including an ear curette, tissue glue, suction, and calling the ear-nose-throat (ENT) specialist. The ear curette won’t work to get around and the kernels are smooth and hard to grasp and might cause trauma with swelling or bleeding. We quickly excluded irrigation because the kernel might swell more. Another method considered was a drop of tissue adhesive onto a q-tip stick to adhere onto the foreign body (FB) for extraction. We were a little leary of this however for fear of gluing the FB to the ear canal and suffering the wrath of ENT.

My resident prepared a 12 Fr Frazier suction catheter, which is good for ear FB’s like insects. The Frazier suction worked well enough to remove one of the kernels from one ear with a little coaxing. The other ear FB did not yield to the Frazier, presumably because the rigid end and smaller diameter does not provide a tight seal on these rounded FBs.

Frazier suction catheter ear FB

 

Trick of the Trade: Modified a 14 Fr suction catheter

After the failed rigid Frazier suction catheter attempts with the second kernel, we used a soft tipped, short suction tubing whose diameter nearly matched the foreign body. The theory was that it might provide a better suction seal. So, the standard 14 Fr suction catheter was cut short and it worked like a charm.

Suction Catheter Ear FB

 

Modified suction ear FB

 

We liked this best because the soft catheter is less likely to cause trauma, if the patient inadvertently moves, and the better suction force that it provided. We guess that it would work equally well in the case of a nasal FB. Ultimately, we feel that suctioning works best with objects having a smooth rounded or flat surface.

Twitter peer review

After posting this trick on Twitter, we received feedback via tweets that a mini-suction made from a cut butterfly needle can work for small beads. We are not sure that would work for larger FB’s like the popcorn kernel but it looks like there are a range of catheter diameters that one can try to find the best fit!

Regarding our concern of tissue adhesive on a q-tip inadvertently gluing the FB onto the ear canal, we learned that one might use an otoscope’s speculum to protect the ear canal from the glue.

Other ear foreign body removal tricks

We’ve also described using a pediatric video laryngoscope trick to provide excellent lighting, exposure, retraction, and magnification to visualize ear FB’s for removal but that would not have helped in this case with a larger ear FB.

Reference

Heim SW, Maughan KL. Foreign bodies in the ear, nose, and throat. Am Fam Physician. 2007; 76(8): 1185-9. PMID: 17990843


Yen Chow, MD CCFP

Yen Chow, MD CCFP

Emergency Physician, Thunder Bay Regional Health Sciences Centre;
Regional Medical Director, Ornge;
Assistant Professor, Emergency Medicine Section, Northern Ontario School of Medicine
  • Daniel Cabrera

    Great tricks. Just a very important reminder, please be extremely careful about tissue glue in the ear canal. I would recommend this only if the foreign body has a smooth regular surface (like the bead in the picture), you can get a good seal with the otoscope speculum, a cooperative patient and experienced operator. Glue in the canal, if the retrieval fails, can make the removal of the foreign body basically impossible without an ENT microscope and surgical instruments. I think Yen’s technique is probably better and safer.

    • Well said, Daniel. It’s a very specific indication for the dermabond-qtip stick trick. Definitely has it’s risks. Thanks for commenting!

    • Yen Chow

      Thanks Daniel! The other nice thing about suction is that it works quick! My other concerns with glue is the time you and the patient have to hold still for it to dry (all the while hoping that it won’t drip into the canal!). The speculum idea is brilliant too but I agree that too much leakage can still happen.

  • Vanessa Cardy

    I definitely recommend NOT using the glue on a Q-tip… We did that once in a rural location and ended up with a kid with a Qtip stuck to the bean that was stuck in his ear. Hard to lie down with a Qtip sticking out of your ear.

    • Oh my! Thanks for sharing your experience with the Q tip. With all procedures there are definite risks. The most common is just failure to get the glue to stick to the bead or glue adhering to the canal wall. Weird that you weren’t able to pull out the bead (edematous canal?). In retrospect, were there signs that this would have failed? Would love to learn from your experience. Thanks!

      • Vanessa Cardy

        The bean had been there for two days and the canal was very edematous. We had tried forceps and then our dental suction, with no success. We decided to try the Qtip and glue trick because we are a tiny hospital, run by a few GPs and a ten hour drive from our nearest referral centre and it seemed worth a shot. Luckily the family were incredibly understanding. In terms of signs that this wouldn’t work, really the length of time that it had been in there was the biggest red flag. I certainly wouldn’t have tried if it closer to a referral centre. A good teaching point for residents- fun to McGuyver stuff but make sure you think it all through and have a back-up plan.

        • Thanks so much for these wise words of wisdom. Frankly I would have done the same thing if I were in your shoes. I always tell our residents that rural practitioners have a WAY harder job than academic practitioners. This is just another example. Keep up the great work!

          • Vanessa Cardy

            Thanks! I am a huge fan of yours and you have no idea how useful your website is for us rural docs in the wilds of northern Canada. As well as your lectures at Essentials… I was using the hair apposition technique the other day and remembering how you demonstrated it using the residents and the sheets…. Thanks for all that you do to help us out with such great tricks. Makes us feel like we are not so alone!

          • Ha that’s funny that you remember the sheets. It’s funny how the silly visuals make things more memorable. Happy to help the true frontline providers — rural docs! Keep it up!

  • KB

    A resident & I had a similar case (unilateral) but also with an unpopped kernel. Our first attempt was with suction, as mentioned in this post, and was unsuccessful. Ultimately (after many other failed ideas/attempts) we used an 18G needle bent as a hook. The resident was very careful not to touch the ear canal but it was just enough to hook the kernel and extract it.