Original Article

Foreign Bodies in Ear - Its Type, Diagnosis and Management

Muhammad Rafique, Arsalan Ahmed Shaikh, Atif Hafeez Siddiqui
ABSTRACT
OBJECTIVES: To evaluate the presentation, nature and fate of aural foreign bodies.
STUDY DESIGN: Descriptive Study.
SETTING: E.N.T. and Head & Neck Surgery department, Liaquat University Hospital Hyderabad
from June 2014 to May 2015.
METHODOLOGY: A prospective study of 224 patients who presented with different aural foreign
bodies. All patients having suspected history of aural foreign body and whom who haven’t his-
tory but during examination foreign body present in ear are included in the study. The patient of
all age group of both the genders was enrolled. All the data was collected on a pre-designed
Performa. Statistical analysis was carried out using SPSS 16.
RESULTS: Out of 224 cases of aural foreign bodies, 50.4% were less than seven years of age,
with male outnumber female. 93.3% of patients were having foreign body in one ear and 6.7%
have foreign body in both ears respectively. Majority of aural foreign bodies were Beads and
pearls that were seen in 30.4%. Most of the cases (87.5%) did not develop any complication
during extraction. The complications observed were canal abrasion in 11 (4.9%) patients, otitis
externa in 12 (5.3%) and tympanic membrane perforation in 02 ( 0.8%) patients.
CONCLUSION: Aural foreign bodies are commonly encountered during otorhinological practice.
Various varieties of aural foreign bodies are prevalent at different parts of the world. These
cases should be removed under good magnification and illumination and/or sedation/general
anesthesia if needed for prevention of complication.
KEY WORDS: Foreign bodies, general Anesthesia, tympanic membrane perforation.

This article may be cited as: Rafique M, Shaikh AA, Siddiqui AH. Foreign Bodies in Ear - Its Type, Diagnosis
and Management. J Liaquat Uni Med Health Sci. 2015;14(02):86-9.
INTRODUCTION of aural foreign bodies has been recognized to gen-
eral curiosity of the children to insert object while play-
An aural foreign body is commonly seen during otolar- ing in home or outside the home into different orifices
yngology practice. The self insertion of foreign bodies of the body like ear, nose etc. Those patient suffering
has been acknowledged to be a common presentation from the ear diseases causing irritation develops regu-
in children and psychologically disturbed patients. lar cleaning habit and therefore prone to accidental
Common aural foreign objects include rubber, erasers, entry of foreign body in ear commonly ear buds etc. 5.
pebbles, beads, safety pins, sponges, and chalk etc1. The purpose of study is to describe the spectrum of
Aural foreign bodies found in all age groups and both the nature of the foreign bodies in this part of the
gender. This condition is frequently seen more in world and outcome of foreign bodies in ear at our insti-
school going children than the infants. Foreign bodies tution.
extract from external auditory canal is routine proce-
dure performed in E.N.T. department. Removal of for- MATERIALS AND METHODS
eign body is not a simple procedure but it need gen- This is a descriptive study carried out in the depart-
eral anesthesia with the help of microscope and espe- ment of ENT – Head & Neck Surgery, Liaquat Univer-
cially designed instrument, so maintaining the integrity sity Hospital, Hyderabad (Sindh). The duration of
of normal anatomy and physiology of external ear2. study is one years, from June 2014 to May 2015. A
Aural foreign body extraction was difficult and chal- prospective study involving 224 patients presented
lenging procedure because of the delicate structure, with different varieties of aural foreign bodies. History
complex anatomy, variety of foreign body and experi- and patients data included age, sex and presenting
ence of the consulting surgeon3. symptoms had been taken as well as complete ENT
Aural foreign bodies are classified in different cata- examination was performed. All patients having sus-
gories i.e. living or non living, metallic – nonmetallic, pected history of aural foreign body and whom who
rounded or multi dimension, soft, firm or hard, and so haven’t history but during examination foreign body
forth, according to their nature4. The pathophysiology present in ear are included in the study. Those

J Liaquat Uni Med Health Sci MAY-AUGUST 2015; Vol 14: No. 02 86
Foreign Bodies in Ear - Actuality of its Diagnosis

Patients who tried to remove their foreign body in FIGURE I: GENDER DISTRIBUTION (n=224)
other hospital or those foreign bodies who cause com-
plications were excluded from this study. The use of
aural syringing, vacuum suction, and manual instru-
mentation by the use of Jobson Horne's probe or hook
and crocodile forceps may be indicated. General an-
esthesia used; mostly in children; only in cases of
poor cooperation, deeply impacted foreign body and
mentally retarded patients. After extraction of foreign
body, re-examination of the affected ear was per-
formed immediately and after three days to exclude
the possible complications. General anesthesia used;
mostly in children; only in cases of poor cooperation,
deeply impacted foreign body and mentally retarded TABLE I:
patients. After extraction of foreign body, re- SITE DISTRIBUTION OF FOREIGN BODY (n=224)
examination of the affected ear was performed imme- Site Number Percentage
diately and after three days to exclude the possible
complications. Bilateral 15 6.7%
All data was recorded and entered in especially de-
Unilateral 209 93.3%
signed proforma and analysed using SPSS V.16. The
1 à Right ear 110 49.1%
data included age, gender, laterality, mode of presen-
2 à Left ear 99 44.2%`
tation, duration of foreign body retained, nature of the
foreign body, method of removal and the development TABLE II: TYPE OF FOREIGN BODY IN EAR (n=224)
of any complications. Finally the results were deduced
Type Number Percentage
and presented in the form of frequencies and propor-
tions. Beads & Pearls 68 30.4%
Cotton bud & Match sticks 50 22.3%
RESULTS
Vegetable seeds 31 13.8%
This study includes 224 patients which having with
foreign body in ear. Out of these 165 (73.6%) were Paper & Rubber 27 12.1%
male and 59 (26.4%) were female and male to female Insects 24 10.7%
ratio was 2.8:1 (Figure I). The mean age was 19 Button batteries 13 5.8%
(±2.1) years, ranged from one year to above 60 years
old. 50.4% (113) of the cases were less than seven Stone and Erica nut 07 3.1%
years of age. TABLE III: FREQUENCY OF COMPLICATION (n=224)
Among 224 patients of foreign bodies, 209 (93.3%) of
patients present unilaterally while 15 (6.7%) of pa- Complication Number Percentage
tients present bilaterally. one hundred and ten (49.1%) No 199 89%
patients had foreign bodies in right ear, 99 (44.2%)
patients in left ear (Table I). Yes 25 11%
Most common types of foreign bodies were Beads and
FIGURE II: TYPE OF COMPLICATIONS DURING
pearls that were seen in 68 patients (30.4%), cotton
EXTRACTION (n=25)
tips and match stick were extracted from 50 patients
(22.3%), vegetable seeds were extracted from 31 pa-
tients (13.8%), Papers and Rubber were extracted
from 27 patients (12.1%), insects were extracted from
24 patients (10.7%), button batteries were extracted
from 13 patients (5.8%), and stone and Arica nut
(Chilia) were extracted from 7 patients (3.1%) respec-
tively (Table II).
Most of the cases did not develop complications 199
(89%) during extraction (Table III). The main compli-
cations were canal abrasion 11 (4.9%) patients, otitis
externa in 12 (5.3%) and tympanic membrane perfora-
tion in 02 (0.8%) patients (Figure II).

J Liaquat Uni Med Health Sci MAY-AUGUST 2015; Vol 14: No. 02 87
Muhammad Rafique, Arsalan Ahmed Shaikh, Atif Hafeez Siddiqui

DISCUSSION A very interesting foreign body reported in an interna-

tional study that the different types of blue tooth de-
Otological foreign bodies are common across the
vices extracted from the external auditory canal. Blue-
ages, it happens in both the children and adult and
tooth device objects were small pieces of magnetic
especially mentally retarded patients. There were nu-
property used with the aid of mobile that communicate
merous of studies conducted in different part of world
with the far distance. This metallic piece was intro-
for looking the prevalence, diagnosis, treatment and
duced through the ear canal and applied in contact
complication of different kind of foreign bodies.
with the tympanic membrane and that different range
In young children the usual site of foreign body inser-
of it15.
tion is ear. Non-living aural foreign bodies may include
Complication due to presence of foreign body or dur-
cotton wool, bean, bead, paper/plastic, eraser, insect,
ing extraction was uncommon. In this study 89% pa-
paddy seed, and popcorn kernel etc6. The patients
tients do not developed any complication during ex-
usually come with the history of pain in the ear and
traction. The complications (11%) noticed were canal
sense of heaviness in the ear and some time dis-
abrasion 4.9% patients, otitis externa in 5.3% and
charge from the ear. Majority of the patient don’t have
tympanic membrane perforation in 0.8% of patients.
any complaint but foreign body found in ear during
This is in sharp contrast to study of Singh et al who
routine ear examination. Examination under anesthe-
reported 77% complication rate16. A probable expla-
sia with an operating microscope helps to confirm the
nation for this contrast finding could be that all pa-
presence of aural foreign bodies; it also helps in re-
tients in our study underwent elective removal of the
trieval of foreign body. It is beneficial in patients who
foreign body; whose shape, type and site found likely
do not allow removal of foreign body without anesthe-
to cause trauma during removal; instead of removal in
sia 7.
emergency or outdoor patient department setting17.
Male preponderance (73.6%) in this study is in agree-
Moreover proper position of the patient and selection
ment with finding of the others. An international study
of appropriate instrument (s) helps in easy removal of
reported 52% male and 48 % female patients8.
aural foreign bodies in patients especially children17.
Shrestha I et al also reported that male are affected
We observed that the rate of complications is high
more than the female9. However one study has re-
after removal of sharp and multi dimension foreign
ported the increased frequency in female10.
bodies. In contrast rounded or soft foreign bodies had
In our study 50.4% of the cases were less than seven
high success rate of removal under direct visualiza-
years of age, a finding consistent with other interna-
tion. The foreign bodies completely occluding the ex-
tional studies11, 12. Chai et al, studied 480 cases of
ternal auditory canal or those stuck up near the tym-
ear foreign body. They reported highest percentage
panic membrane may be removed by special de-
(48.3%) of aural foreign bodies in less than five years;
signed hock; yet the removal is associated with com-
followed by children between 6 and 10 years13.
plication.
In this research we found that the majority of foreign
bodies in ear were Beads and pearls that were seen CONCLUSION
in 30.4%, cotton tips and match stick were 22.3%,
Aural foreign bodies are prevalent in all parts of the
vegetable seeds were 13.8%, papers were 12.1%,
worlds; when removed under good magnification and
insects were 10.7%, button batteries were 5.8%, and
illumination and/or sedation/general anesthesia car-
stone and Arica nut (Chilia) were 3.1% patients re-
ries minimum rate of complications.
spectively. There were wide variations regarding the
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AUTHOR AFFILIATION:
Dr. Muhammad Rafique (Corresponding Aurthor)
Associate Professor, Department of ENT
Liaquat University of Medical & Health Sciences
(LUMHS), Jamshoro, Sindh-Pakistan.
Email: rafique.kaimkhani@gmail.com

Dr. Arsalan Ahmed Shaikh

Assistant Professor, Department of ENT
LUMHS, Jamshoro, Sindh-Pakistan.

Dr. Atif Hafeez Siddiqui

Assistant Professor, Department of ENT
Dow University of Health Sciences Karachi, Sindh-Pakistan.

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