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HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

TREATMENT

■ If alive, consider lidocaine or alcohol to sedate the insect before attempting

extraction.

■ Do not irrigate absorbent material (vegetables) or batteries.

■ Remove FB with probe, forceps, or irrigation (use of cyanoacrylate glue on

the tip of a paper clip has also been described).

■ Postextraction, always reexamine to rule out TM perforation, canal damage,

ossicle bone damage.

■ Topical antibiotics are recommended postextraction if canal damaged.

■ If unable to remove an ear foreign body, immediate consultation should be

obtained for patients with severe pain, suspected TM rupture, embedded

button battery or evidence of infection. Otherwise, 24-hour follow-up is

acceptable.

Tympanic Membrane Perforation

ETIOLOGY

■ Penetrating object

■ Complication of infection (acute otitis media, myringitis)

■ Blast injury (explosion, slap, or lightening)

■ Barometric pressure changes (flying or scuba diving)

SYMPTOMS/EXAM

■ Pars tensa most common area of the TM to perforate (thinnest part, anterior

and inferior)

■ Pain and decreased hearing (conductive hearing loss)

■ Bleeding may be present (see Figure 14.4).

FIGURE 14.3. Auricular hematoma.

(Courtesy of C. Bruce Macdonald, MD as published in Knoop KJ, Stack LB, Storrow AB. Atlas of

Emergency Medicine,2nd ed. New York: McGraw-Hill, 2002:20.)