Otomicroscope in the emergency department management of pediatric ear foreign bodies

Abstract

To determine the effect of a dedicated otomicroscope in the emergency department (ED) management of complex ear foreign bodies (FB). Prospective analysis of 85 patients with complex pediatric ear FB's. 65 (76%) of 85 FB's were successfully removed in the ED. 54 (63%) had previous attempted removal, 27 (31%) were less than age 4, 37 (44%) had ear FB's present longer than 24h, 3 (4%) had multiple ear FB's, and 9 (11%) had an external auditory canal (EAC) comorbidity prior to attempted removal. 31 (36%) were touching the tympanic membrane (TM). 20 (23%) had complications with removal with EAC laceration most common and no TM perforations or hematomas. Mean and median number of attempts for removal was 1.65 and 1.0. Successful removal was associated with the location of the FB, presence of an EAC comorbidity, and number of attempts (p<0.05). Complication rate was associated with an EAC comorbidity and number of attempts (p<0.05). EAC comorbidity was more common in FB's touching the TM (p<0.05). Increased number of attempts was associated with use of sedation (p<0.05). The implementation of an otomicroscope into the ED resulted in successful removal of complex pediatric ear FB's with few attempts and a low rate of serious complications.