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Foreign bodies in the nose and ear: a review of techniques for removal in the emergency department
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  1. P H Davies,
  2. J R Benger
  1. Emergency Department, Frenchay Hospital, Bristol
  1. Correspondence to: Dr Davies, Specialist Registrar, Emergency Department, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW (e-mail: carophil{at}primex.co.uk)

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Patients frequently present to the emergency department for removal of foreign bodies from the nose or ear. Early descriptions of foreign body removal from Roman times include “An insect must first be killed with vinegar and then removed with a probe; the patient should be encouraged to sneeze or better still he should be bound to a table with the affected ear downwards and the table struck with a hammer so that the foreign body may be shaken out of the ear”.1

Little scientific evidence regarding the best method of foreign body removal exists. The diverse nature of the problem has precluded randomised controlled trails and the medical literature consists mainly of anecdotal case reports. Unfortunately it sometimes seems as if the cavalier attitude to these problems has changed little from those 2000 years ago. The following review attempts to provide a logical, up to date approach to this common complaint.

Methods

Medline 1966 to August 1998 was searched using the OVID interface and the search terms [{exp foreign bodies OR foreign body.mp} AND {exp nose OR nose.mp OR exp ear OR ear.mp}] LIMIT to human and English language. All appropriate articles were retrieved and further searched for relevant references, which were in turn followed up until a complete picture of all previous literature was assembled. These papers were supplemented by information from major ear, nose, and throat (ENT) and emergency medicine textbooks.

Aetiology and epidemiology

Patients presenting with foreign bodies in the nose or ear are predominantly children in the 2 to 8 age group.2 Foreign bodies in the nose are less common than those in the ear and occur almost exclusively in children. The earliest presentation is likely to be around the age of 9 months when a child develops a pincer grip, allowing easy manipulation of small objects.3

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