Difficult Case of Middle Ear Foreign Body: An Unusual case report with review of literature

Abstract

Introduction: Foreign bodies in the external auditory canal are very common in
children, mostly farm seeds and small stones in farmer. Removal of the foreign body Ear
requires skill, and also high accuracy. Failures and traumatic removals often cause
lifelong deafness and discharging ear. We report a case of a child who accidentally
inserted a stone in ear while playing in farm and two casual removal trials pushed it into
the middle ear. Case Presentation: A 4-year-old girl Patient was brought to tertiary care
hospital attached with medical college two day after the insertion of foreign body with
complaints of severe earache, something present in the ear and history of bleeding from
the ear. History of two failed removal attempts in last forty eight hours at two different
clinics was present with one attempt under general anaesthesia. We found that the
tympanic membrane was ruptured, with granulation tissue in the middle ear and there
were multiple lacerations in ear canal and oedema causing severe narrowing .No foreign
body was visualised. Further on a CT scan examination stone was located in the middle
ear and lodging itself in the hypo tympanum crossing the bony annulus. The foreign body
was removed via a post-auricular approach after removal of overlying granulation tissue
and widening of ear canal with use of micro motor mastoid drill. The perforated drum
was repaired in the primary surgery after inspection of the ossicular chain and middle ear
using a temporalis fascia graft. Conclusion: Removal of a foreign body from external
auditory canal is an essential skill for emergency care giver as well as otolaryngologists.
This particular case focuses the need of utmost carefulness and care in treating such
seemingly simple cases. Slightest of error can give the patient lifelong deafness and
prolonged morbidity. Whenever possible, primary reconstruction of the ear drum should
be done in the same sitting.