Learning outcomesAt 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.

TM SJ 2017

Management and removal of EAR foreign bodies

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.

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

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

TYPE OF FOREIGN BODY

NON-LIVING SPONGE ERASER PAPER WOOD COTTON BUDSLIVING BEANS NUTS WORMS MAGGOTS

BEAD METAL STONES PLASTIC TOYS BUTTON BATERY

ORGANIC INORGANIC

•Nuts beans insect worm

ORGANIC-(living):

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

INORGANIC:

•Metal beads button stone batery

INVESTIGATIONOTOSCOPY

HOW TO REMOVE?

DEPENDS ON THE TYPE OF FOREIGN BODY AND ITS LOCATION .

TECHNIQUE OF TREATMENT

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

BLUNT HOOK

useful for round smooth object but not if impacted.

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.

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

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.

INSECTS

Olive oil is used to drown lives insect in the external

auditory.

Crocodile forceps are then used to remove the insect

COMPLICATION1. 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.

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

PATIENT’S BACKGROUND

Admit paediatrics ward.

She is 3 yrs old malay girl.

No past medical/surgical history.

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.

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.

PYSICAL EXAMINATIONOUTER PINNA

Bilaterally outer pinna normal

No oedema and redness.

No tenderness

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.

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

DAILY REVIEW Patient was review and Tarivid ear

drops 3 drops BD Left ear was added.

Contninue medication as ordered

Cont:

Vital signs patient was stable , patient

comfortable with minimal pain,no

bleeding.

After day 5 i/v Augmentin ,patient was

procced for EUA.

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

EUA PROCEED EUM was done after patient sedated

RESULT:

1. No foreign body.

2. Granulation tissue left ear

3. Tympanic membrane perforation

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

- 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

Follow up 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 

NURSING DIAGNOSIS

AND

NURSING INTERVENTION

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.

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.

1)

Fear and anxiety related to procedureObjective : 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 .

health education before discharge

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.

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:

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.

ANY QUESTION?

THANK YOU

THANK YOU