Foreign bodies in external auditory canal

A SURVEY of the records of The Mount Sinai Hospital reveaIs that foreign bodies in the external auditory canal occur most commonly in young female children between two and one-half and seven years of age, the right ear being involved more frequently than the left. The experiences of Keen, l however, are not in accord with ours; of 5 I cases of foreign body in his series, omitting the cotton wool variety, there were 23 in the right ear, 27 in the left and one not stated. Keen advanced the explanation that five or six year old children when playing, are really ambidextrous. Previous unsuccessful attempts at removal were the rule in our patients. This is in agreement with the experiences of PoIitzer2 who stated that hardly I o per cent of the cases which come to the specialist had not undergone some manipulation. Some of the foreign bodies removed by us included beans, peas, a piece of porcelain crockery, glass beads of varied sizes and shapes, a tooth, a button, small pieces of graphite from a lead pencil, pieces of onion and cotton. The commonest foreign body encountered in adults, according to Asherson,3 is cotton wool which generally is inserted by the patient and forgotten. Other authors have reported finding fruit seeds, pebbles, glass, shot, insects, larva, coffee beans, slate, etc. Foreign bodies in the external auditory canal may be divided into two groups, those which cause few, if any symptoms and those which cause severe symptoms. I. Foreign Bodies Which Cause Minimal Symptoms. Occasionally during the course of an otoIaryngologic examination, a foreign body may be discovered in the ear. For example, a child was referred to the Out Patient Department for an opinion as to the advisibility of tonsillectomy. On Iooking into the external auditory canal, one saw a round red object which moved when the head was rotated into various positions. It was ascertained upon questioning the parent, that the child frequently pIayed with a red bead necklace. On syringing the external auditory canal with warm water a small bead was washed out. Another patient was seen in the clinic complaining of foul smelling discharge from the right ear of many years duration. The canal wall close to the tympanum was covered with granulations. There was considerabIe purulent discharge in the externa1 auditory canal and the tympanic membrane was not visible. Upon touching the granmations with a probe, the dirty grayish area which was thought to be the inner tympanic wall covered by granulations, moved. With a bayonet forceps, the grayish mass was gently loosened and removed. To our surprise, it was a piece of cotton about +d inch thick, encrusted with calcium salts. The drum was found intact. Within a few days, the granulomata on the canal wall disappeared and “the middle ear discharge” of many years duration ceased. PoIitzer2 reported an instance in which a piece of slate 3 cm. long was present in the external auditory canal for fifty years with no complaints other than deafness. The patient was seventy years old at the time of the r&nova1 of the slate and compIained onIy of poor hearing. Zaufa14 and Lucae5 reported removing cherry stones from the external auditory canal of asymptomatic patients after forty and forty-two years respectiveIy. Wells6 reported a case of deafness of thirty-three years duration resulting from pIacing a pea into the