Foreign Body Removal from the Ear
I recently treated a young patient with a cylindrical metallic foreign body in the ear canal (no, it wasn't a battery - it was a tiny fuse). The smoothness and rounded edges of the object made grasping with alligator forceps impossible. The width of the object prohibited the use of a cerumen spoon since the object fit the canal almost perfectly. The only magnets we could find were the weak EMS advertisements on the refrigerator, and my lame attempt at using a suction catheter was entirely ineffective. Because I couldn't tell how close the object was to the eardrum, I chose not to attempt the balloon-tipped catheter method in which a small catheter is advanced past the foreign body and a small balloon is inflated, allowing removal of the object as the catheter is withdrawn.
Ultimately I tried irrigation, but since I've not heard this specific technique used before, I thought I'd report it. I removed the object by irrrigating with Auralgan.
Auralgan is a topical anesthetic which also contains glycerine. It's a thick solution that is quite viscous yet also very slimy. Using a 5cc syringe and a 20g angiocath, I directed the tip of the catheter at the edge of the object. Apparently there was just enough room between the ear canal and the cylindrical object for the solution to pass by. The consistency of the Auralgan provided superior back pressure as well as excellent lubrication which made what was until then a frustrating procedure seem ridiculously simple. One small squirt and we were done.
If anyone else tries this (or has tried it before), let me know how it went.
Ultimately I tried irrigation, but since I've not heard this specific technique used before, I thought I'd report it. I removed the object by irrrigating with Auralgan.
Auralgan is a topical anesthetic which also contains glycerine. It's a thick solution that is quite viscous yet also very slimy. Using a 5cc syringe and a 20g angiocath, I directed the tip of the catheter at the edge of the object. Apparently there was just enough room between the ear canal and the cylindrical object for the solution to pass by. The consistency of the Auralgan provided superior back pressure as well as excellent lubrication which made what was until then a frustrating procedure seem ridiculously simple. One small squirt and we were done.
If anyone else tries this (or has tried it before), let me know how it went.
Labels: tips
posted by scalpel at 4:12 AM
14 Comments:
I'm gonna have to try to remember this one. Nice tip!
Did you have to knock the patient out?
Neat idea.
One of the things that has worked for me with things like beads is putting a little super glue (or Dermabond) on the end of a cotton swab (usually helps to fray the end of the swab a little bit), sticking it to the object, waiting about 30 seconds, and then pulling it out.
Doesn't work all the time, but one more trick to try.
I see a political joke in there somewhere...
How did you know that the auralgan would not be ototoxic? Seems kind of scary-yet-clever to me.
Very clever. I'll have to remember your tip. I love when we get to employ MacGyver-esque techniques with our job!
Are pacer magnets not readily available in the ER?
Seems Shadowfax had trouble locating theirs recently.
Maybe ya'll need to put out a call to your local pacer reps and get a few pacer magnets to glom onto the code cart.
(Pacer magnets are standard on our crash carts)
CardioNP
hehe, I was just going to say that- pacer magnet. Where I was an EKG tech we always had a pacer magnet on our cart, so even if you didn't have one in the ER, I'm sure the EKG dept. could have brought one. It still might not have worked, of course, but I'm curious now >).
Fortunately the kid was cooperative, so no sedation was required. I thought long and hard about the superglue trick, but the fuse was wedged in the canal relatively firmly and I was afraid I wouldn't have enough adhesion to pull it out. Plus I was a little scared of gluing it in there and making things worse. That would have been embarrassing.
I'm not positive that the fuse contained magnetizable metal, but I was really wishing I had a strong magnet at the time to try that first.
Braden - I assume with a name like auralgan, its designed for use in the ears.
I have done this successfully but with saline. I prescribed auralgam and cortisporin otic afterwards.
Was it the old auralgan that you had lying around, or the "new improved" auralgan that pharmacies are foisting upon patients whose unwitting physicians wrote for "Auralgan," not knowing that there's a new name-brand product for which no generic exists, and that it isn't the same as what USED to be called auralgan? The new stuff has an antibiotic and antifungal in it. see:
http://tinyurl.com/4rqqyc
I work in primary care and regularly remove cerumen from the patients ears. I use warm water with a 60cc syringe, metal tip, and a basin to collect what comes out.
My neighbor, knowing I work for a doctor, came over to my house after a bee, yes a bee, went into his ear canal. He threw some rubbing alcohol into his ear and succesfully killed the bee. So, I used the same technique and flushed an entire dead bee out of his ear.
This technique works well...
i managed to have bee crawl into my ear; a bee keeper had me turn my head so the affected ear was facing up. he then lit a cigarette lighter, held it close so the bee could see the light and bee crawled out. no sting all this happened at dusk.
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