Corpus Alienum Telinga [PDF]

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CASE REPORT



Corpus Alienum Auricular



Presented by: Afifah Al Azizah Ma Wan Hui Muhammad Ifan Alfian Gavrilo Giardi Azaria N. Paramastri Dinda Ajeng A.



17/421280/KU/20211 17/421304/KU/20235 17/421308/KU/20239 17/421297/KU/20228 17/421286/KU/20217 17/421289/KU/20220



Moderator: Dr. dr. Sagung Rai Indrasari, M.Kes., Sp. THT-KL (K), FICS



Departement of Otorhinolaringology, Head and Neck Surgery Faculty of Medicine Universitas Gadjah Mada RSUP Dr. Sardjito 2018



INTRODUCTION



The objects themselves are variable,



The ear is an organ for hearing and



ranging from beads to insects. Cases are



balance, which consists of the external ear,



seen mostly but not exclusively in children



middle ear and inner ear. The external ear



and are a relatively common case in



captures sound waves that are converted



emergency



into mechanical energy by the middle ear.



sometimes realize that a foreign object is



The middle ear converts mechanical



lodged inside their external ear canal,



energy into nerve waves, which are then



coming in with the chief complaint the



delivered to the brain. The inner ear also



insertion of a foreign object in their ear.



helps maintain body balance.



But some may not even realize the



medicine.



Patients



may



The external ear consists of earlobes



presence of an object in their ear canal,



(pinna or aurikel) and ear canal (meatus



leading up to patients presenting with



auditory externa). The outermost part of



hearing loss, or a sense of fullness.



the ear which is the auricle is composed



Significant discomfort, or complain of



mainly by elastin cartilage and skin. It



nausea and vomiting may be present if a



consists of: root/crus of the helix, helix,



live insect enters the ear canal.1



antihelix, scaphoid fossa, triangular fossa,



In children, the child does not



crura of antihelix, antitragus, lobule, and



complaint before the pain due to infection



tragus. The external acoustic meatus is an



in the ear, the ears can be smelled bad if



“S” shaped canal that leads to tympanic



the foreign body stay for a long time in the



membrane from the auricle. 1/3 of the



ear canal. If the child’s ear smelled bad,



outer part of the canal is composed of



parents should suspect it as a result of



cartilage while 2/3 of the canal’s inner part



foreign body in the ear canal. Do not



is made out of bone (temporal), with its



handle it yourself because the objects may



length measured to be around 2.5-3 cm.



actually go inside because of the anatomy



The cartilaginous part of the canal



of the ear canal that is notched. In the ears



produces cerumen from sebaceous and



there are many nerves and injuries can



ceruminous glands, while 2/3 of the bony



occur. Foreign body in the ear canal



part of the canal has only a few of these



usually can only be evacuated by ENT



glands compared to the other.



doctors using equipment and specific



Foreign body (corpus alienum) in the



skills.



ear are objects lodged in the ear which



Foreign bodies in the ears, nose or



originates from outside the body or even



throat are a common occurrence in



from within which is normally not present.



otorhinolaryngology



(ENT)



emergency



services.



Foreign



bodies



have



been



laceration of the skin and the wound of the



estimated to account for approximately



tympanic membrane, it will cause hearing



11% of the cases seen in ENT services.2



loss, ear pain / otalgia and possible risk of



There are several factors that can cause foreign objects in the ear that is 3:  Intentional factor, usually occurs in



infection. Severe complications can occur in 22% of the cases found, and the morbidity associated with foreign bodies, therefore,



children under five.  Carelessness factors often occur in



foreign matter must be handled correctly.2



adults when using earwashers such as



Improper handling can lead to bleeding,



cotton, a matchstick or sticker left



trauma to the ear canal, trauma to the



inside the ear, the latter being accidental



membrane tympanic and hearing bones.



factors in which a foreign object enters



This will increase the patient's morbidity,



the



so it will require exploratory action with



ear



for



example



insects,



cockroaches, flies and mosquito.



general anesthesia to remove the foreign



Here are some foreign objects that



object. Lack of experience in foreign body



often enter the ear canal: water, cotton



management in the ear is one of the factors



bud, small things and insect. The effects of



causing iatrogenic complications.4



the entry of foreign matter into the ear can range in no symptoms until the symptoms



CASE REPORT



of severe pain and the presence of hearing



A 19 years old female visited RSUD



loss. Other symptoms that may arise are:



Tjitrowardojo Purworejo on January 18th,



feeling uncomfortable, clogged, impaired



2018 because she claims an insect-like



hearing and earache / otalgia.



thing burrowed itself in her right ear since



The entry of foreign objects into the



this morning. She also complained a



ear that is to the external auditorius canal



feeling of discomfort in her right ear.



will cause a clogging sensation in the ear,



Tinnitus, discharge and itchiness were



so the patient will try to remove the



denied.



foreign object. However, the actions that



swimming, cleaning the ear canal with



the patient undertakes to expel the foreign



cotton bud, and scratching her ear with



body often leads to further exacerbation of



nails. She has seen the doctor in primary



the foreign body to the external canal



health care before going to RSUD



bone, causing skin laceration and injury to



Tjitrowardojo Purworejo. The doctor said



the tympanic membrane. As a result of



that the insect-like thing were burrowed



There



was



no



history



of



deep in the right ear and there were no



adequate equipments to evacuate the thing



physical examination, the patient was



so she had to go to the ENT specialist. She



diagnosed with Corpus Alienum Auricular



has no history of food allergy as a kid. She



Dextra. The evacuation of the foreign



also denied nasal congestion, cough,



body was done, and no drug was



hoarseness and upper respiratory infection



prescribed to the patient.



before her complaints appeared. On otoscopic examination, the left ear



DISCUSSION



was within normal. The external auditory



The patient present with a feeling of



canal of the left ear was not hyperemic, no



discomfort in the right ear. Physical



discharge and no swelling. The tympanic



examination revealed a foreign body deep



membrane were intact with good light



in the CAE with no discharge, tenderness,



reflection. The patient felt no pain when



redness, and swelling on the right ear.



we



Based on the signs and symptoms we



palpated



her



left



ear



and



the



paraauricular area.



diagnosed the patient with corpus alienum



Compared to the left ear, the right ear



auricular



dextra.



The



physical



was within normal. The external auditory



examination is the main diagnostic tool for



canal was not hyperemic, no discharge,



corpus alineum in the ear canal.



and no swelling but we can see the foreign



Physical examination is done with the



body deep in the ear, right in front of the



use of an otoscope while retracting the



tympanic



tympanic



pinna in a posterosuperior direction. A



membrane itself were intact. There were



head mirror with a strong light source,



no pain when we palpated her right ear and



operating



paraauricular area. Inspection of the



microscope also may be used. The result



external nose was normal. From anterior



that may be gathered from the examination



rhinoscopy examination, both of her



are:



nostril



• Redness, foul odor and swelling indicate



membrane.



was



normal,



The



no



edema



or



otoscope,



or



operating



hyperemic concha and no discharge was



infection



seen.



• The bluish color and cone shaped



Physical examination on the throat was



within



the



normal



limit.



indicate a pile of blood behind the tympanic membrane.



Tonsilopalatina, pharynx, larynx was in



• The possibility of a tympanic membrane



normal limit, no swelling nor hyperemic



perforation.



were seen. No granule was seen in oropharynx. Based on history taking and



There is



no specific



prehospital



management for the presence of a foreign



body, immediate visit to the hospital is



since the catheter must be placed



needed. Occasionally if the patient suffers



directly on the object with a good seal



from



nausea,



obtained. The catheter does not work as



be



well for foreign bodies in the medial



discomfort,



symptomatic



pain,



or



treatment



can



administered to the patient.



two thirds of the ear canal where it is



There are some tools that required for



narrower, and it is sometimes difficult



removal foreign body:



to keep enough suction pressure on



 Otoscope for ensure the located foreign



theforeign body for removal.  Magnet. It is used for metallic foreign



body.  Headlamp



used



for



lighting/



bodies.  Mineral oil or lidocaine 2%. It is used



visualization.  Curved hook. This tool is ideal for hard, spherical shaped objects in the lateral



to kill the insect in the ear canal.  Sedation (if needed)



one third of the ear canal.



There are 3 techniques commonly



 Alligator forceps. The most common



used by practitioner to evacuate the foreign



tool used for removal of an ear foreign



bodies: mechanical extraction, irrigation,



body. The alligator forceps is ideal for



and suction. In this patient, the technique



graspable objects such as paper, erasers,



used was irrigation because the foreign



cotton or tissue. They are not ideal for



body was a small accessory located in the



hard, spherical shapes such as beads



inner two third of CAE, right in front of



(unless there is a hole) or seeds.



the



Alligator forceps are also useful when



extraction and suction techniques are best



the foreign body can be directly



used when the foreign bodies had a mushy



visualized from the external ear canal.



consistency. The side effect was minimal



 Irrigation



equipment.



Syringe



and



tympanic



membrane.



Mechanical



after the foreign body evacuation, so no



angiocatheter 20 gauge usually is used



drug was prescribed to the patient.



for irrigation in the ear canal.



• Mechanical extraction



 Suction equipment. One of the tools for



Briefly repeat the ear examination



suction is catheter. The catheter is ideal



while observing the location and depth of



for hard, round, spherical



shaped



the foreign body. Move the headlamp for



objects specifically in the lateral one



better visualization and carefully introduce



third



alligator



of



the



ear



canal.



Direct



visualization of the objectis important



forceps



through



ear



canal.



Advance the forceps incrementally through



the external auditory canal until the foreign body is grasped. Gently withdraw the



• Suction Connect



the



soft-tipped



suction



forceps, with attached foreign body, from



catheter to low wall suction and position



the auditory canal. Always check for



the patient comfortably. Visualize the



complete removal of the foreign body,



foreign body with the headlamp/otoscope.



perforation of the tympanic membrane,



Introduce the catheter through ear canal



and abrasions of the auditory canal.



and gently advance it incrementally until



• Irrigation



the foreign body is contacted. Gently



To irrigate, first attach a 20-ga angiocatheter



to



a



60-mL



withdraw the suction catheter tip and



syringe.



attached foreign body from the external



Warming the irrigation fluid (water or



auditory canal. Repeat a postprocedural ear



normal saline) greatly enhances patient



examination to confirm complete removal



comfort. Position the patient comfortably



of the foreign body and to check for



and drape the area to keep the patient dry.



complications.



Position an emesis basin under the affected



Insects, organic matter and objects



ear to collect irrigation runoff. Place the



with the potential to become friable and



flexible angiocatheter tip gently in the



break into smaller evasive pieces are often



external auditory canal. Advancing the tip



better extracted with suction than with



too far risks damage to the tympanic



forceps. Live insects in the ear canal



membrane. With the angiocatheter tip held



should be immobilized before removal is



gently in position, slowly inject irrigation



attempted.5 The insect should be killed



fluid until the foreign body washes out.



prior to removal, using mineral oil or



Always conduct a postprocedural ear



lidocaine 2%.6-7



examination to confirm complete removal



Always examine the opposite ear for



of the foreign body and to check for



additional foreign bodies and the external



complications.



auditory canal after the removal of a



Irrigation



is



contraindicated



for



foreign body to identify preexisting or



organic matter that may swell through



iatrogenic



osmosis and enlarge within the auditory



perforations or abrasions.



canal. Disk batteries and vegetable matter



tympanic



membrane



There are some prevention for the



are also absolute contraindications to



entry of object in the ear, that:



irrigation.



 The habit of using cottonbud to clean the ears should be stopped because it can cause some side effects: our ears



which have fine hairs that are useful for making sweeping movements of dirt in



4.



our ears will be damaged, so this natural cleansing mechanism will be



5.



lost. If our skin is blistered there can be a very uncomfortable outer ear infection and other possibilities if we are too deep in pushing cottonbud, it can injure



6.



or penetrate the eardrum.  Avoid giving toys in the form of seeds to the children since the children can put the small toys into the ear or can also be swallowed. It can be fatal if it clogged the airway.



CONCLUSION A 19 years old woman was presented with Corpus Alienum Auricular Dextra. The evacuation of the foreign body was done with irrigation and no prescribed drug was given. The diagnosis was defined by the clinical presentation of the patient.



REFERENCES 1. Wright A. Anatomy and Ultrastructure of the Human Ear, Basic Science, Dalam : ScottBrown's Otolaryngology, 6"' ed, Vol I, Oxford ; Butterworth- Heinemann Ltd. 2. Fornazieri MA, Cutolo D, Moreira JH, et al. Foreign-body in External Auditory Meatus: Evaluation of 462 Cases. Intl. Arch. Otorhinolaryngol., São Paulo – Brazil. 2010;14(1):45-49. 3. Heim SW, Maughan KL. Foreign Body in the Ear, Nose, and Throat. University of Virginia School of Medicine, Charlottesville, Virginia.



7.



Am Fam Physician. 2007, Oct 15; 76(8): 1185-89. Edwad Y, Fitria H. Trauma pada Tingkap Lonjong Akibat Ekstraksi Benda Asing di Liang Telinga. 2013. Figueiredo RR, Azevedo AA, Kos AO, Tomita S. Complications of ent foreign bodies: a retrospective study. Braz J Otorhinolaryngol. 2008 Jan-Feb. 74(1):7-15. Antonelli PJ, Ahmadi A, Prevatt A. Insecticidal activity of common reagents for insect foreign bodies of the ear. Laryngoscope. 2001 Jan. 111(1):15-20. Leffler S, Cheney P, Tandberg D. Chemical immobilization and killing of intra-aural roaches: an in-vitro comparative study. Ann Emerg Med. 1993 Dec. 22(12):1795-8.