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Observation
September 2016

Destructive Otologic Foreign Body: Dangers of the Expanding Bead

Author Affiliations
  • 1Department of Otolaryngology, Children’s National Medical Center, Washington, DC
  • 2Department of Otolaryngology, Walter Reed National Military Medical Center, Bethesda, Maryland
  • 3Department of Diagnostic Imaging and Radiology, Children’s National Medical Center, Washington, DC
JAMA Otolaryngol Head Neck Surg. 2016;142(9):919-920. doi:10.1001/jamaoto.2016.1870

Foreign bodies of the external auditory canal (EAC-FB) are a common presentation to the emergency department (ED), with an estimated 280 000 visits from 2008 to 2012 in the United States.1 Cases are evaluated and treated with irrigation, suction, or surgical instrumentation. Otic drops are given if there is secondary canal trauma or inability to remove EAC-FB.2 One-third of patients require otolaryngology referral; 75% of these referrals consist of round or firm objects best removed under otomicroscopy and are seen on a less urgent basis. Expedient evaluation is indicated in cases associated with infection secondary to canal trauma from unsuccessful removal.3 Urgent referral is indicated for materials with potential for destruction, such as button batteries. Two patients were diagnosed with an EAC-FB that expanded within the ear canal leading to tympanic membrane (TM) perforation, ossicular erosion, and in a prolonged case, otic capsule erosion resulting in permanent auditory and vestibular loss. The FB in each case was identified as a water-expanding bead marketed as a children’s toy.

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