Pediatric Foreign Bodies in the Ear, Nose and Airway

Foreign bodies can either be in the ear lobe or in the ear canal. Objects usually found in the ear lobe are earrings, either stuck in the lobe from infection or placed too deep during insertion. Foreign bodies in the ear canal can be anything a child can push into his or her ear. Some of the items that are commonly found in the ear canal include the following:

• Food
• Insects
• Toys
• Buttons
• Pieces of crayon
• Small batteries

It is important for parents to be aware that children may cause themselves or other children great harm by placing objects in the ear.

The reason children place things in their ears is usually because they are bored, curious or copying other children. Sometimes, one child may put an object in another child's ear during play. Insects may also fly into the ear canal, causing potential harm. It has also been noted that children with chronic outer ear infections tend to place things in their ears more often.

Objects that are put into the child's nose are usually soft things. These would include, but are not limited to, tissue, clay, and pieces of toys or erasers. Sometimes, a foreign body may enter the nose while the child is trying to smell the object. Children often place objects in their noses because they are bored, curious or copying other children.

A foreign body in the airway (choking) constitutes a medical emergency and requires immediate attention. The foreign body can get stuck in many different places within the airway. According to the American Academy of Pediatrics, death by choking is a leading cause of death and injury among children younger than 4 years of age.

As with other foreign body problems, children tend to put things into their mouths when they are bored or curious. The child may then inhale deeply and the object may become lodged in the "airway" tube (trachea) instead of the "eating" tube (esophagus). Food may be the cause of obstruction in children who do not have a full set of teeth to chew completely, or those children who simply do not chew their food well. Children also do not have complete coordination of the mouth and tongue which may also lead to problems. Children under the age of four years are in the greatest danger of choking on small objects, including, but not limited to, the following:

• Seeds
• Toy parts
• Grapes
• Hot dogs
• Pebbles
• Nuts
• Buttons
• Coins

Children need to be watched very closely to avoid a choking emergency.

Some objects placed in the ear may not cause symptoms, while other objects, such as food and insects, may cause pain in the ear, redness or drainage. Hearing may be affected if the object is blocking the ear canal.

The most common symptom of a foreign body in the nose is nasal drainage. The drainage appears only on the side of the nose with the object and often has a bad odor. In some cases, the child may also have a bloody nose.

Foreign body ingestion requires immediate medical attention. The following are the most common symptoms that may indicate a child is choking. However, each child may experience symptoms differently. Symptoms may include:

• Choking or gagging when the object is first inhaled
• Coughing at first
• Wheezing (a whistling sound, usually made when the child breathes out)

Although the initial symptoms listed above may subside, the foreign body may still be obstructing the airway. The following symptoms may indicate that the foreign body is still causing an airway obstruction:

• Stridor (a high-pitched sound usually heard when the child breathes)
• Cough that gets worse
• Child is unable to speak
• Pain in the throat area or chest
• Hoarse voice
• Blueness around the lips
• Not breathing
• The child may become unconscious

The treatment for foreign bodies in the ear is prompt removal of the object by your child's physician. The following are some of the techniques that may be used by your child's physician to remove the object from the ear canal:

• Instruments may be inserted in the ear
• Magnets are sometimes used if the object is metal
• Cleaning the ear canal with water
• A machine with suction to help pull the object out

After removal of the object, your child's physician will then re-examine the ear to determine if there has been any injury to the ear canal. Antibiotic drops for the ear may be prescribed to treat any possible infections.

Treatment of a foreign body in the nose involves prompt removal of the object by your child's physician. Sedating the child is sometimes necessary in order to remove the object successfully. This may have to be performed in the hospital, depending on the extent of the problem and the cooperation of the child. The following are some of the techniques that may be used by your child's physician to remove the object from the nose:

• Suction machines with tubes attached
• Instruments may be inserted in the nose

After removal of the object, your child's physician may prescribe nose drops or antibiotic ointments to treat any possible infections.

Treatment of the problem varies with the degree of airway blockage. If the object is completely blocking the airway, the child will be unable to breathe or talk and his or her lips will become blue. This is a medical emergency and you should seek emergency medical care. Sometimes surgery is necessary to remove the object. Children that are still talking and breathing but show other symptoms also need to be evaluated by a physician immediately.