Management of foreign body in ear

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1. Learning outcomes At 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.

2. TM SJ 2017 Management and removal of EAR foreign bodies

3. 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.

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

5. 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

6. TYPE OF FOREIGN BODY NON-LIVING SPONGE ERASER PAPER WOOD COTTON BUDS LIVING BEANS NUTS WORMS MAGGOTS BEAD METAL STONES PLASTIC TOYS BUTTON BATERY ORGANIC INORGANIC

7. Nuts beans insect worm ORGANIC-(living):

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

9. INORGANIC : Metal beads button stone batery

10. INVESTIGATION OTOSCOPY

11. HOW TO REMOVE?

12. DEPENDS ON THE TYPE OF FOREIGN BODY AND ITS LOCATION .

13. TECHNIQUE OF TREATMENT

14. 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

15. BLUNT HOOK useful for round smooth object but not if impacted .

16. 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 .

17. 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

18. 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.

19. INSECTS Olive oil is used to drown lives insect in the external auditory. Crocodile forceps are then used to remove the insect

20. COMPLICATION Acute complications of ear foreign body removal include canal abrasions, bleeding, infection. perforation of the tympanic membrane. Otitis externa / otitis media Foreign body granuloma Tetanus may occur from sharp infected foreign bodies .

21. 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

22. PATIENT’S BACKGROUND Admit paediatrics ward. She is 3 yrs old malay girl. No past medical/surgical history.

23. 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.

24. 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.

25. PYSICAL EXAMINATION OUTER PINNA Bilaterally outer pinna normal No oedema and redness. No tenderness

26. 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 .

27. 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

28. DAILY REVIEW Patient was review and Tarivid ear drops 3 drops BD Left ear was added. Contninue medication as ordered

29. Cont: Vital signs patient was stable , patient comfortable with minimal pain,no bleeding. After day 5 i/v Augmentin ,patient was procced for EUA.

30. 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

31. EUA PROCEED EUM was done after patient sedated RESULT: 1. No foreign body. 2. Granulation tissue left ear 3. Tympanic membrane perforation

32. 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

33. - 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

34. 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  

35. NURSING DIAGNOSIS AND NURSING INTERVENTION

36. 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.

37. 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.

38. Fear and anxiety related to procedure O bjective : 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 .

39. health education before discharge

40. 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.

41. 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:

42. 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.

43. ANY QUESTION?

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