A 3-year-old girl is brought by her parents to an urgent care facility after a day of crying, irritability, scant otorrhea, and frequent pulling of her right ear. Otoscopy reveals an erythematous, swollen external auditory canal (EAC) where a bead is wedged (Figure 28-1). The patient is referred to an otolaryngologist and the bead is removed using an operating microscope for visualization.

• Children with ear foreign bodies (FBs) usually present with otalgia, otorrhea, or decreased hearing. At times, symptoms may be nonspecific, like irritability and crying. Other times, presentation may be asymptomatic.

• Ear FBs are commonly seen in children ages 1 to 6 years.1–3
  
• Equal male-to-female ratio in the pediatric population.4

• Most common FBs in children include:5
  
  
  
  • Inanimate objects such as beads (see Figure 28-1), cotton tips, paper, toy parts, crayons (Figure 28-2), eraser tips, food, or organic matter, including sand (Figure 28-3), sticks, and stones.
    
  • Insects (Figure 28-4).
  
  
• Pathogenesis includes some of the key elements of otitis externa (see Chapter 27, Otitis Externa):
  
  
  
  • Initial breakdown of the skin-cerumen barrier (caused by presence of FB).
    
  • Skin inflammation and edema leading to subsequent obstruction of adnexal structures (e.g., cerumen glands, sebaceous glands, and hair follicles).
    
  • FB reaction leading to further skin injury.
    
  • In the case of alkaline battery electrochemical reaction, severe alkaline burns may occur.

• Children with attention deficit hyperactivity disorder (ADHD) may be more likely to self-insert FBs and ADHD should be considered in children with ear FBs who are older than age 5 years.6