XXXX : management practices and outcomes.

@entity1 @entity2167
OBJECTIVES/HYPOTHESIS: The purpose of the study was to evaluate the effectiveness of @entity2167 by health care practitioners and to explore outcomes of @entity1 with unsuccessful initial removal attempts. STUDY DESIGN: Retrospective case series. METHODS: A case series of @entity1 presenting with @entity2167 to the emergency department of the authors' institution (Strong Memorial Hospital, University of Rochester Medical Center) over a 3-year period was studied retrospectively. Medical records were reviewed, and information including age at presentation, type of foreign body, side of presentation, length of time in place, signs and symptoms at presentation, management practices, and outcomes was recorded. RESULTS: One hundred sixty-two @entity1 with a diagnosis of @entity2167 were identified. Emergency personnel successfully managed 67% of @entity1 using direct visualization techniques, and 33% required otolaryngological consultation. Otolaryngologists used otomicroscopy with standard otological instruments as their mainstay of management. Analysis of successfully managed emergency department cases revealed that 82% of foreign bodies were irregularly shaped objects with soft, graspable parts. Conversely, 72% of foreign bodies in otolaryngology referrals were firm, rounded objects such as beads and beans. Analysis of @entity1 referred to otolaryngologists revealed a requirement for removal under anesthesia of 19%. @entity1 with a history of one or more removal attempts before emergency department evaluation universally failed further direct visualization techniques. A disproportionate number of these @entity1 eventually required operative intervention and/or had tympanic membrane perforation. @entity1 with a history of previous removal attempt(s) who were referred directly to otolaryngologists were more likely to be successfully managed without general anesthesia. CONCLUSION: Emergency room personnel successfully manage the majority of @entity1 with foreign bodies of the external auditory canal. For @entity1 with firm, rounded objects, direct otolaryngology consultation without further manipulation should be strongly considered. @entity1 who have had previous removal attempts should not undergo further manipulation in the emergency department but rather should be referred directly to an otolaryngologist.
