Safety and Efficacy of a Protocol for In-Office Pediatric Aural Foreign Body Removal.

Objectives: To examine the safety and efficacy of a step-by-step protocol for the office removal of aural foreign bodies (FB) in a pediatric population.

Methods: All children presenting to an academic pediatric outpatient department were identified from a computerized collection of office notes and operative reports. FB removal was performed in a standard fashion including: (1) pre-procedure discussion with shared decision making, (2) restraint in a supine position with a trained second person holding the head, (3) FB removal using an operative microscope and instrumentation. A case was considered a failure if subsequent removal under sedation or general anesthesia was required.

Results: 447 total cases (ears) were identified in 428 children (19 had bilateral FBs). 201/428 (47%) of children had previous attempts at FB removal elsewhere. 431/447 (96.4%) of FBs were successfully extracted in the office. 16/447 (3.6%) of FBs were removed in the operating room. Out of the 431 successful removals, two patients had minor complications (ear canal lacerations). No child suffered a more severe complication. The failed removal group was more likely to have a documented neurodevelopmental disorder (4/21 vs. 12/407, p = 0.0001).

Conclusion: This protocol resulted in a high rate of successful FB removal, even in children with prior failed attempts. There were no significant ear injuries in this 22-year experience, which included children with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder. This approach should be considered by otolaryngologists who care for children in the office setting.

Level of evidence: 3-Retrospective review.