Children and adults commonly present to the emergency department with a foreign body lodged in the ear. Over the past 15 years techniques for cyanoacrylate (“superglue”) assisted foreign body removal have been described, but are not widely employed. Two cases of successful and one of unsuccessful removal using this technique are reported, and some advice is offered to aid others.
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Foreign body within the ear is a common problem presenting to emergency departments. Most patients are inquisitive children in the 2 to 8 age group,1 but adults can also present in this way.2 Patients are more commonly male and of low socioeconomic status.3 During a recent 12 month period 74 patients (representing approximately one in 500 new attendances) presented to our emergency department with a foreign body lodged in the ear. Of these 30 (41%) were adults and 44 (59%) children. This rate is rather more than that of one in 1792 new patient registrations reported from the John Hopkins emergency department in 1987.3
Many different techniques have been advocated for the removal of foreign bodies lodged in the ear,4 though very few of these have been formally assessed in any scientific way, relying more on anecdote and experience.5
We report two cases of successful and one of unsuccessful removal of a foreign body from the external auditory canal using cyanoacrylate “superglue”, and make some further observations based upon our experiences.
Technique for removal
In the following cases we used a blunt plastic stick, such as that contained in a “cotton bud”. The cotton wool was removed and a small amount of cyanoacrylate glue applied. This was then introduced into the ear under direct vision until the foreign body was contacted. A drying time of 30 to 60 seconds was allowed, after which the foreign body was extracted with a smooth, pulling motion.
A general practitioner referred a 60 year old woman with an asymptomatic foreign body in her ear. Removal was initially attempted with forceps, but the patient found this too painful. Instead the foreign body was removed easily using cyanoacrylate glue.
A 17 year old woman placed a plastic pearl in her right ear and was unable to remove it. In the emergency department the pearl was easily visualised and removed using cyanoacrylate glue (see fig 1).
A 4 year old girl pushed a plastic bead into her ear. The bead was visualised deep within the ear canal, but several attempts at removal using cyanoacrylate glue failed due to a lack of patient cooperation and the plastic stick becoming detached from the bead. The patient was referred for removal under general anaesthesia.
The first reported use of glue to remove a foreign body from the ear was published in 1977.6 This described two successful cases in which a general purpose adhesive was applied to the end of a flexible plastic rod. Three subsequent reports using cyanoacrylate glue have been published, the earliest in 1984.7 In 1989 Pride and Schwab claimed the first reported use of cyanoacrylate glue for the successful removal of a foreign body from the ear, and suggested that a larger series would be helpful.8 Four years later Hanson and Stephens successfully applied this technique to the nose and ear of a 3 year old girl and 14 year old boy respectively,9 but beyond this no further information or evaluation has been published.
Though it is clear that cyanoacrylate extraction of foreign bodies can be highly successful, the efficacy of this technique in relation to the many others available remains uncertain. It is likely to be most useful in extracting hard, spherical objects such as those described above. These are difficult to remove with forceps, but may be amenable to extraction using a Fogarty biliary catheter10 or suction device,11 and as a result the role and value of cyanoacrylate techniques remains unclear.
Above all, these cases illustrate the requirement for a cooperative patient, good light, direct vision, and manual dexterity. Although Thompson7 and Hanson and Stephens9 both report success with children, we are doubtful whether many youngsters are capable of staying still for the time it takes the glue to dry, and would suggest that in the absence of sedation this technique may prove most applicable to adults.
Removal of foreign bodies from the ear using cyanoacrylate glue is more useful in adults than children as a high degree of cooperation is required. There is considerable scope for further research into this particular removal technique, and for a formal comparison of the various extraction methods currently in use.
Jonathan Benger and Philip Davies worked together to initiate and develop this case report. Jonathan Benger collected the clinical data and drafted the paper. Philip Davies contributed to the literature review and edited the paper.
Both authors act as guarantors for the paper.
Conflict of interest: none.