This document provides information on managing and removing ear foreign bodies in children. It begins by outlining the learning objectives which include describing signs and symptoms, identifying foreign body types, preparing equipment, differentiating complications, planning nursing care, and providing health education. Common foreign bodies are then described including location in the ear. Techniques for removal depending on type and location are explained. Potential complications are outlined. The case study provides background on a 3-year-old girl admitted with a bead lodged in her ear along with her treatment course and nursing care including health education provided at discharge.

2. Learning outcomes
At the end of the online lecture, student should be able to:
1.Describe the sign and symptoms children with foreign
body in the ear.
2. Identify the type of foreign body correctly.
3. Prepare the equipment correctly.
4. Differentiate the warning sign of complication .
5. Plan the quality nursing care for the patient.
6. Recommend health education with confident.

3. TM SJ 2017
Management and removal of EAR
foreign bodies

4. INTRODUCTION
•FOREIGN BODY, EAR
• Condition where something is present in the ear that is
not normally there.
1. Common in children especially toddlers
2. Although they can be found in adults.

5. SIGN AND SYMPTOMs
 Ear pain
 Ear discharge
 Loss of hearing in one ear
 Reduced hearing
 Fretfulness of child
 Child scratching at the ear

6. WHERE IT STUCK?• Most foreign bodies will lodge either
lateral to the isthmus or impacted to
the site.
• Located in the deep meatus they may
reside in the anterior recess

8. TYPE OF FOREIGN BODY
NON-LIVING
 SPONGE
 ERASER
 PAPER
 WOOD
 COTTON BUDS
LIVING
 BEANS
 NUTS
 WORMS
 MAGGOTS
 BEAD
 METAL
 STONES
 PLASTIC TOYS
 BUTTON BATERY
ORGANIC INORGANIC

9. •Nuts beans insect worm
ORGANIC-(living):

10. ORGANIC-(NON-LIVING) :
•sponge wood eraser cotton
buds

11. INORGANIC:
•Metal beads button stone
batery

12. INVESTIGATION
 OTOSCOPY

13. HOW TO REMOVE?

14. DEPENDS ON THE TYPE OF FOREIGN BODY AND
ITS LOCATION .

15. TECHNIQUE OF TREATMENT

16. Equipment
 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

17. BLUNT HOOK
 useful for round smooth object but not if impacted.

18. CROCODILE FORCEP
 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.

19. 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

21. EAR SYRINGING
 Ideal for most foreign bodies excepts if vegetable
material and organic type.
 Irrigation must be avoid with vegetable material and
organic type because this causes welling of the object
and makes removal more difficult.

23. INSECTS
 Olive oil is used to drown lives insect in the external
auditory.
 Crocodile forceps are then used to remove the insect

24. 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. Foreign body granuloma
5. Tetanus may occur from sharp infected foreign bodies.

25. TIPS AND WARNING
 Repeated attempts at removal are unkind
 If foreign is not visual abandon the procedure-
( PLEASE REFER TO DOCTOR )
 To be careful during the procedure.
TYMPANIC MEMBRANE WILL INJURED

26. PATIENT’S BACKGROUND
 Admit paediatrics ward.
 She is 3 yrs old malay girl.
 No past medical/surgical history.

27. PRESENT HISTORY
OUT PATIENT DEPARTMENT
 Complaint of left ear discharge for one month. After
the patient having upper respiratory tract infection.
 According to mother the girl have insert (scarf
beads) in the left ear and removed by her mother.
 Only removed 3 pcs only and complaint still left
1( scarf beads) inside the ear.

28. CONT:
 Was refer to Otorhinolaringology, Hospital X.
 She was given antibiotic augmentin 10/7 but still no
any improvement.
 Hospital X Intan refer again to Hospital Y for futher
management.

29. PYSICAL EXAMINATION
OUTER PINNA
 Bilaterally outer pinna normal
 No oedema and redness.
 No tenderness

30. Otoscopy was done .
•-Right ear
wax with Tympanic membran intact
-Left ear
pus with granulation tissue occluding external Aqustic canal,
Tympanic membran not visualised for left ear.

31. TREATMENT
Patient was admitted:
- Start i/v Augmentin 225 mg tds,
-Paracetamol Syrup 225 mg PRN
-To review if not resolving
- KIV for EUA on Thursday

32. DAILY REVIEW
 Patient was review and Tarivid ear
drops 3 drops BD Left ear was added.
 Contninue medication as ordered

33. Cont:
 Vital signs patient was stable , patient
comfortable with minimal pain,no
bleeding.
 After day 5 i/v Augmentin ,patient was
procced for EUA.

34. PRE - OP
 For anaest to review, seen by anaest, proceed for EUA as planned.
 Keep NBM at 12 MN,
 IVD 52 ml/hr Halfsaline Dextrose 5 % once NBM
 Blood investigation :
 Fbc - normal
 Renal Profile - normal
 GSH
 Consent by mother/father
 Vital signs

35. EUA PROCEED
 EUM was done after patient sedated
 RESULT:
1. No foreign body.
2. Granulation tissue left ear
3. Tympanic membrane perforation

36. PROGRESS REPORT OF PATIENT
- Afternoon ward round
 6 hours post EUM and removal of granulation tissue left ear, patient stable,
 no fever, taken orally, complaint of mild dizziness with vomitted once.
-Physical examination done :
 Left ear Popewick insitu
 No bleeding seen
 Plan: continue antibiotic
 Continue sofradex
 Off ivd once tolerating well

37. - Patient seen at clinic
EUM left ear - popewick removed
superior perforation of TM seen
granulation tissue seen near TM
popewick reinserted
Plan: patient discharge with medication.
TCA1 week
Syrup augmentin 225 mg bd x 1/52
Syrup PCM 225 mg qid
Taravid ear drop left ear 3 drops bd

38. Followup at clinic:
After 1 week
Patient well, no fever.
Popewick removed, TM perforation with granulation at TM
smaller ,no pus seen.
Plan : continue popewick
After 2 weeks
Patient well, popewick removed , left ear granulation tissue
less, much improved
Plan : continue ear drop
After 3 weeks
Patient defaulted TCA

39. NURSING DIAGNOSIS
AND
NURSING INTERVENTION

40. Potential infection related to deficit knowledge regarding ear
care .
 Obj: No infection and patient understand about ear care
1. Keep ear dry to avoid infection because wet is good place
for microrganism to spread .
 wear ear plug while bathing
 Put cotton wool wet with olive oil in ear while bathing
to avoid water getting inside the ear.
 No swimming or diving.

41. 2. Wipe the external ear after bathing with dry soft
towel.
3. Dont put any tradisional medicine in ear to avoid
infection.
4. Don’t dig the ear with cotton bud because can cause
trauma to ear canal and the cerumen will become
impacted and will be infected.

42. Fear and anxiety related to procedure
Objective : patient told the fear and anxiety reduced
1. Talk with patient smoothly, for patient not to afraid of doctors
and nurses.
2. Tell the procedure to patient , for patient co-operation.
3. Ask mother to always beside with patient for moral support,
and not fear .

43. health education
before discharge

44. health education
1. Wipe the outer ear with a dry cloth or tissue
to dry the ear.
2. Do not use cotton bud to clean the ear
canal, it’s cause trauma and the
cerumen will become impacted.
3. Do not use pins or sharp pointed objects to
clean your ears, because these objects may
injured the ear canal or eardrum.

45. 4.Tell the patient , do not put anything into ear
and nose, it’s cause trauma and infection .
5.Tell the parents, treating upper respiratory
infections promptly to reduce the risk of ear.
6. See doctor or come to hospital immediately
if sign and symptom of infections e.g. redness,
fever, pain, ottorhea for early treatment.
Cont:

46. Cont:
7. Choose a suitable play toys for your children to make
sure the safety.
8. Seek the doctor if you notice foreign body insitu
for early treatment .
9. Continue follow up to clinic regularly as ordered to
review the progress of .
treatment.
10. Continue take medication as ordered especially
antibiotic to avoid resistant to antibiotic.

48. THANK YOU
THANK YOU