A 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.
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.
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.
@M_Lin @TBayEDguy here's @cabreraERDR's contraption, with the bead adhered to the end. (Dr. Lin you're a hero btw!) pic.twitter.com/XTGKLhpHMJ
— Brent Core (@BrentCoreMD) August 19, 2015
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.
Heim SW, Maughan KL. Foreign bodies in the ear, nose, and throat. Am Fam Physician. 2007; 76(8): 1185-9. PMID: 17990843