Typical aural foreign bodies (Beads, toy parts, cotton, paper, insects — most common ages 2–8 years (AAP, ENT UK))
Clinical presentation (Ear pain, itching, hearing loss, crying, or witnessed insertion; examine both ears and TM (AAP, NICE, ENT UK))
First-line therapy
ED removal — direct vision • procedure
Duration: Same visit · Visible FB with intact TM — curette, alligator forceps, or irrigation; limit attempts (AAP, ENT UK)
• Assessment: otoscopy with good light; assess TM integrity before irrigation or oil instillation.
• Non-insect FB: removal with curette, alligator forceps, or gentle warm-water irrigation if TM intact.
• Insect in ear: immobilize first with mineral oil, olive oil, or 2% lidocaine (if no TM perforation suspected) — do NOT use water irrigation while insect is alive.
• After insect is killed/immobilized: remove with curette or gentle irrigation; suction if available.
• Limit to 1–2 skilled attempts — refer ENT if unsuccessful, uncooperative child, or TM injury risk.
No routine antibiotics • —
Duration: Not indicated · Antibiotics only if otitis externa or TM perforation with infection develops (AAP, ENT UK)
• Successful removal with intact TM: observe, no antibiotics; return if pain, discharge, or hearing loss.
• ENT referral: failed removal, uncooperative child, suspected TM perforation, or organic FB (beans, seeds).
• TM perforation after removal: keep ear dry, ENT follow-up; topical antibiotics only if infected.
Clinical notes
• Assessment: otoscopy both ears; confirm TM status before any irrigation or oil instillation (AAP, ENT UK).
• Insect in ear: kill/immobilize with oil or 2% lidocaine (no TM perforation) — never water-irrigate a live insect; remove after immobilization (AAP, ENT UK).
• Routine removal: curette or forceps for graspable objects; gentle irrigation only if TM intact and object is not hygroscopic (AAP).
• Limit attempts: max 1–2 per clinician; failed removal or uncooperative child — ENT referral (ENT UK, NICE).
• Post-removal: observe for bleeding or pain; return if otorrhea, persistent pain, vertigo, or hearing loss (ENT UK).
• AAP — Foreign bodies of the ear (2024)
• ENT UK — Paediatric aural foreign body guideline (2024)
• NICE — Ear problems in children principles (2021)
