Foreign body removal from the external auditory canal in a pediatric emergency department

Objectives: To describe the experience with external auditory canal foreign body removal in a pediatric emergency department. To identify factors associated with procedural complications and/or failed removal. Methods: Retrospective case series of patients treated in the emergency department over a 5-year period. Primary outcomes include success and complication rates. Secondary outcomes include removal rates in the otolaryngology clinic and operating room. Results: Physicians in our pediatric emergency department successfully removed 204 (80%) of 254 foreign bodies. In 30 cases (12%), there was a complication. Multiple attempts at removal were associated with failure (relative risk [RR], 6.0; 95% confidence interval [CI], 3.0-12.0) and complications (RR, 3.1; 95% CI, 1.5-6.3). The use of multiple instruments was also associated with failure (RR, 5.4; 95% CI, 2.7-10.8) and complications (RR, 4.0; 95% CI, 2.0-7.6). Of the 244 patients in whom emergency department attempts at removal were made, 26 were successfully removed in otolaryngology clinic, and 14 were removed in the operating room. Foreign bodies present in the canal for more than 24 hours were not at higher risk of failed removal or complications. Patients younger than 4 years also were not at increased risk of having failed removal or complications. Conclusions: Physicians in a pediatric emergency department remove most foreign bodies from the external auditory canal successfully with minimal complications and need for operative removal. These data suggest that referral to otolaryngology be considered if more than I attempt or instrument is needed for removal.