Table of Contents

2015 Month : August Volume : 4 Issue : 67 Page : 11762-11768

A RARE FOREIGN BODY IN THE EAR: REMOVED BY CANALOPLASTY: A CASE REPORT.

T. Shankar1, D. Ranganath Swamy2, T. Vivechana3

1. Professor, Department of ENT, Osmania Medical College, Hyderabad.
2. Assistant Professor, Department of ENT, Osmania Medical College, Hyderabad.
3. Resident, Department of ENT, Osmania Medical College, Hyderabad.

CORRESPONDING AUTHOR:
Dr. T. Shankar.
Flat No. 401, Plot No. 59 & 62,
GK’s Rishitha Mari Gold Apartments,
Hasthinapuri Colony, Sainikpuri,
Hydrabad-500094.
Telangana State.
E-mail: drshankar_ms@yahoo.com

ABSTRACT:  Getting an object impact in the ear canal is a relatively common problem in children, the majority of items are lodged in the external auditory canal which is the small channel that ends at the ear drum. The children often place these items in their ears out of curiosity. Common objects found in ear include beads, toys, food material, insects and seeds etc. usually foreign body ear are removed by syringing or with Hartmann’s forceps, we are here presenting a case of foreign body in the middle ear removed by canaloplasty through post-aural approach.

KEYWORDS:  Foreign body, ear canal, canaloplasty, middle ear cavity, tympanic membrane.

How to cite this article

T. Shankar, D. Ranganath Swamy, T. Vivechana. A Rare Foreign Body in the Ear: Removed by Canaloplasty: A Case Report. Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 67, August 20; Page: 11762-11768, DOI: 10.14260/jemds/2015/1695

Introduction:  The children often insert foreign bodies in their ears out of curiosity. Foreign bodies in the external auditory canal are more common in children than adults, children often do not tell their parents that they have put foreign body in the ear for fear of being beaten, it is often goes undetected and may be found incidentally. In rural areas of developing countries a dead housefly or maggots is commonly seen in the ears of children having ear discharge due to CSOM.

Anatomy of External Auditory canal/Middle Ear:

 

Fig. 1: Anatomy of EAC


 

External auditory canal: (Figure No. 1):  It is 2.5cm long in adults and extends from the bottom of the concha to the tympanic membrane. The outer 1/3rd is cartilaginous and inner 2/3rd is bony part, the tympanic membrane lies obliquely at the medial end of external auditory canal. The external auditory canal is a ‘S’ shaped tortnous canal and this tortnosity helps to protect the tympanic membrane form injury, medially and anterio inferiorly the bony wall dips down to form a recess called the anterior recess. It is difficult to visualize and even more difficult to remove foreign bodies and debris lodged in anterior recess.

 

Fig. 2: Anatomy of middle Ear


Middle Ear Cavity: (Figure No. 2): It lies between the external auditory canal and the inner ear and it is shaped like a match box standing vertically.

 

Parts of the Middle Ear Cavity:

  • Epitympanum (Attic):  Part above the malleolar folds.
  • Mesotympanum:  Part just medial to the pars tensa.
  • Hypotympanum:  Part that lies below the lower border of tympanic membrane.

 

Contents of the Middle Ear:

  • Three Ossicles – 1. Stapes 2. Incus 3. Malleus.
  • Two Nerves – 1. Chorda Tympani 2. Tympanic plexus.
  • Two Muscles – 1. Tensor tympani 2. Stapedius.

 

Common Foreign Bodies in the External Auditory Canal:

  • Inanimate foreign body:  Sponge, eraser, pieces of paper, lead of Pencil, & cotton wool.
  • Vegetable matter:  Beans, seeds etc.
  • Insects:  Housefly, maggots, flea, tick etc.

Common Symptoms in the Foreign Body Ear:  The symptoms of having a foreign body in the ear largely depends on the size, shape and substances involved:

  • Pain is the common symptom.
  • Decrease in hearing.
  • Irritation to the ear canal can also make patient nauseated.
  • Bleeding is also common, especially if the object is sharp or if try to remove it by sticking something else in to the ear.
  • Occasionally a foreign body in the ear will go undetected and cause an infection in the ear, ongoing infectious drainage from the ear.
  • The insect’s movement can cause a buzzing in the ear and may be quite uncomfortable.

Treatment: Methods of Removal of Foreign Body Ear:

  • Ear Syringing:  Ideal for most of the foreign body removal specially when microscope is not available.
  • Removal under Microscope:  This is safest method of removal of foreign body with help of either suction, Jobson Horne’s Probe, blunt ear hook or micro ear forceps.
  • Use of Head Mirror and Ear Instruments:  With help of ear hook, micro ear forceps or Jobson Horne’s Probe.
  • Live insects in the external auditory canal should be first killed by putting oil, 2% xylocaine drops or water in external auditory canal and then only removed, most of the foreign bodies can be removed without anaesthesia, however in uncooperative children or an impacted foreign body, should be removed under general anaesthesia using microscope or otoendoscope to avoid damage to ear drum and pushing the foreign body in to the middle ear cavity, which makes ultimate removal of the object more difficult.

CASE REPORT:  A 12 year male child brought to the OPD, Govt. ENT Hospital, Koti, Hyderbad, with chief complaints of insertion of foreign body in the (L) ear, patient was apparently asymptomatic 10 days back, he was developed pain in the (L) ear and taken to private hospital at Nizamabad, there it was diagnosed as foreign body in the ear canal, local doctor was made an attempt to remove the foreign body and failed, finally the case was referred to our hospital for better treatment.


On Examination:  External auditory canal was filled with blood clots, no other findings, after necessary investigations the case was posted for endoscopic removal of foreign body under general anaesthesia.

Operative Procedure:  Under aseptic condition with help of 00 endoscope, external auditory canal was cleaned with normal saline to remove the blood clots, the foreign body (Grayish white beat) seen in the middle ear cavity, foreign body was mobilized with help of a probe and tried to remove, we also failed to remove, since it was very much impacted in hypo tympanum of middle ear, after two to three attempts, we have decided to go post-aurally to remove the foreign body. The post aural incision was given, tympanomeatal flap elevated, foreign body seen tried to remove, it was so much impacted there was no space to negotiate the foreign body.

Fig. 3: Intra Operative Photos.

A:  Elevating the tympanomeatal flap.

B: Canaloplasty.

C:  Foreign body in the Middle Ear.

D:  Foreign body, after removal.