Foreign bodies refer to any object that is placed in the ear, nose, or mouth that is not meant to be there and could cause harm without immediate medical attention.

1. Presented on 4th April 2019 at 9:00
FOREIGN BODY IN THE EAR AND NOSE
By Dr NDAYISABA CORNEILLE
INTERNATIONAL HEALTH SCIENCE UNIVERSITY
04/04/2019 Dr Ndayisaba Corneille1

2. INTRODUCTION
• Foreign bodies refer to any object that is placed in the ear,
nose, or mouth that is not meant to be there and could cause
harm without immediate medical attention.
• It is important for parents to be aware that children may
cause themselves or other children great harm by placing
objects in the ear.
• The reason children place things in their ears is usually
because they are bored, curious, or copying other children
• Although they can b found in adults
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3. WHERE IS IT STUCK
• Most foreign bodies will lodge in
lateral to isthmus
• Others may lodge in the deep
meatus where they can hide in the
anterior recess (objects lodged
here may not be readily visible on
otoscopy)
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4. CLEAR IMAGE SHOWS WHERE IT STUCK
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5. SIGN AND SYMPTOM
• Ear pain(Otalgia)
• Ear discharge (otorrhea)
• Loss of hearing in one
ear Which is affected
• Reduced hearing
• Restlessness
• Swelling of external ear
• Insect buzzing in ear
• Child scratching at the ear
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6. TYPE OF FOREIGN BODY
INANIMATE:
• Vegetable FB :paes ,beans
• Mineral FB : metal ,
plastic toys , button batery
• Others:cotton buds,sponge
ANIMATE:
• Maggot
• Worms
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7. Factors influencing successful removal
• Immobilisation of patient
• Size and shape of FB
• Ability to visualise FB
• Repeated attempts at removal (the first attempt is
usually the best chance in a young child)
• Available equipment
• Experience and skill of operator.
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8. FB Ear Management
• Removal options will depend on the type of object and
its location in the canal
• The best suited technique for the particular object and
location, will increase the success rate
• Ensure good lighting preferably with a headlight, so that two
free hands can be used: for traction on ear with one hand and
removal of the object with the other hand
• A cooperative or restrained patient (by an assistant) is
necessary to provide removal from a still patient
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9. Cont…..
Methods of removing a foreign body include:
• (i) Forceps removal
• (ii) Syringing
• (iii) Suction
• (iv) Microscopic removal with special instruments
• (v) Postaural approach
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10. cont……
• Soft and irregular foreign bodies like a piece of paper,
swab or a piece of sponge can be removed with fine crocodile
forceps.
• In all impacted foreign bodies or in those where earlier
attempts at extraction have been made, it is preferable to use
general anaesthetic and an operating microscope.
• Occasionally, postaural approach is used to remove foreign
bodies impacted in deep meatus, medial to the isthmus or those
which have been pushed into the middle ear.
• Don’t remove living insects, the insect should be killed by
instilling oil spirit or chloroform water.
• Once killed, the insect can be removed by any of the methods
described above.
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11. • Otoscope with
removable lens
• Microscopic otoscope
• Headlamp
• Jobson horne hook
• crocodile forceps
• Syringe
• Gauze
• Emesis basin
• suction equipment and
tubbing
• Magnet for metallic
foreign bodies
Ear speculum
Zoellner sucker
Galipot
Olive Oil
Some équipement required
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12. A pairs of crocodile forceps can easily
graps objects such as cotton wool , paper
,pieces of foam sponge and insects.
Should not be use to remove smooth
round objects.
CROCODILE FORCEPS
MICROSUCTION
Suction is satisfactory for the majority
of foreign bodies.
Removal should be perform with an
microscope to avoid trauma to the canal
or tympanic membrane
Ideal for most foreign bodies excepts if
vegetable material and organic type.
Irrigation must be avoid with vegetable
material and organic type because this
cause swelling of the object and makes
removal more difficult.
EAR SYRINGING
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13. • Olive oil is used to drown lives
insect in the external
auditory.
• Crocodile forceps are then used
to remove the insect
useful for round smooth object
but not if impacted.
INSECTS
BLUNT HOOK
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14. COMPLICATION
• 1. Acute complications of ear foreign body removal
include canal abrasions, bleeding, infection.
2. perforation of the tympanic membrane.
3. Otitis externa / otitis media
4. hairing loss
5. Tetanus may occur from sharp infected foreign
bodies.
6.Facial nerve palsy may occur secondary to leakage
of alkaline matter from the button battery &
necrosis of the surrounding tissue.
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15. FB in the nose
Aetiology:
• Common in children.
• My be organic or
inorganic
• Pieces of paper, chalk,
button, pebbles,sponge,
and seeds are the
common objects.
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17. Clinical features
• • Unilateral fetid discharge:
mucopurulent or blood
stained
• u/l nasal obstruction
• Pain
• Nasal bleed
• Excoriation of nasal
vestibular skin
• Complaints of pain or
difficulty breathing through
that side of the nose.
• Nasal bleeding is also common because the tissues of
the nose can be scratched.04/04/2019 Dr Ndayisaba Corneille 17

18. • Vomiting resulting from the blood which drips down
the back of the throat and swallowed.
• Chocking since the nasal space connects to the to the
back of the mouth, it is possible for an object to be
pushed into the throat.
• Infections due to forgotten foreign body.
• Nasal discharge from one side of the nose.
• Sinusitis due to frequent infections to the sinuses and
blockage of the drainage sites of the sinuses.
• Foul odor resulting from the foreign body which has
been in the nose for a long period of time.04/04/2019 Dr Ndayisaba Corneille 18

19. INANIMATE FB REMOVAL:
• Child is restrained in upright position
• Add few drops of nasal
decongestant
• Proper suctioning to visualise FB
• Curved hook is passed
beyond FB and gradually
drawn forward and removed
completely
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20. USING FOGARTY CATHETER
• Additional method
• Ensure that balloon is intact
• Catheter is placed beyond
the foreign body
• Balloon is then inflated
• Catheter is withdrawn
through the anterior
nares pulling the foreign
body04/04/2019 Dr Ndayisaba Corneille 20

21. INDICATIONS FOR GENERAL ANAESTHESIA
• • Uncooperative and very apprehensive patients
• If troublesome bleeding is anticipated
• If the FB is posteriorly placed with a risk of pushing it
back in to nasopharynx
• If a foreign body is strongly suspected but cannot be
seen in anterior rhinoscopy and radiolucent
• Patient is anaesthetised with cuffed ET tube
• Pharyngeal pack placed
• If FB is placed posteriorly , patient positioned in rose
position and mouth gag applied.
• Palate is generally retracted with a catheter which is
placed through unaffected nasal cavity
• FB is pushed from anterior nares in to the nasopharynx
and pick up with foreps04/04/2019 Dr Ndayisaba Corneille 21

22. Complications of FB nose
. A foreign body left in the nose
may result in:
(i) Nasal infection and sinusitis.
(ii) Rhinolith formation(Usually forms
around the nucleus of a small exogenous
FB, blood clot ,inspissated secretion by
slow deposition of calcium and magnesium
salts)
(iii) Inhalation into the
tracheobronchial tree.
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23. Prevention
• Teaching a child that it is not good to put anything
inside the nose
• Approach the child in a nonjudgemental way so that
the objects can be discovered and safely removed
before complications.
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THANKS FOR YOUR
ATTENTION