History

Presenting context

Foreign body history

OPQRST

Onset

Provocation and palliation

Quality

Region and radiation

Severity

Timing

Associated symptoms

Ear symptoms

Nasal symptoms

Airway symptoms

Prior attempts and baseline

Removal attempts prior to arrival

Baseline hearing and nasal patency

Alarm Features

Immediate threats

Airway risk

Button battery exposure

Magnet exposure

Uncontrolled bleeding

High risk objects and scenarios

Sharp or penetrating object

Caustic or expanding material

Infection or complication concern

Vital sign danger thresholds

Instability

Medications

Current and recent medications

Bleeding risk medications

Immunosuppression

Procedural medications

Topical anesthesia options

Topical vasoconstrictors for nares

Sedation and analgesia

Analgesia

Procedural sedation triggers

Procedural sedation examples

Diet

NPO and aspiration considerations

Recent oral intake

Aspiration risk modifiers

Review of Systems

System screen

Constitutional

HEENT

Respiratory

Neurologic

Collateral History and Family History

Collateral sources

Source and reliability

Family and household context

Household exposures

Supervision reliability

Risk Factors

Patient factors

Pediatrics

Bleeding risk

Infection risk

Object related risks

Button battery

Magnet

Differential Diagnosis

Life threatening

Airway foreign body aspiration (T17.2)

Button battery injury

Severe epistaxis with instability

Common

Foreign body in external ear (T16)

Foreign body in nose (T17.1)

Otitis externa (H60.9)

Rhinitis and sinusitis (J32.9)

Less common

Tympanic membrane perforation (H72.90)

Epistaxis from mucosal trauma (R04.0)

Perichondritis of pinna (H61.0)

Past Medical History

Relevant conditions

ENT history

Coagulation and bleeding history

Sedation risk history

Physical Exam

Initial survey and vitals

Stability and monitoring needs

Perfusion

Ear exam

Otoscopy and auricle

Vestibular and neuro symptoms

Nasal exam

External nose and septum

Bleeding assessment

Oropharynx and airway

Airway and secretion handling

Chest exam if aspiration concern

Lab Studies

When labs are useful

Bleeding concern

Infection concern

Pitfalls and limits

Normal labs do not exclude mucosal necrosis from button battery

Imaging

Scoring Systems

Not routinely indicated

MRI

Generally not indicated

CT

Indications

Key cautions

Ultrasound

Limited role

Pitfalls

Special Tests

Bedside ENT techniques

Visualization aids

Ear foreign body removal options

Nasal foreign body removal options

Insect in ear canal

Consultation triggers

ENT consultation

ECG

When ECG is relevant

Not routinely indicated

Sedation related monitoring

Baseline rhythm documentation

Assessment

Problem representation

Foreign body location and risk category

Complications to rule out

Ear related

Nasal related

Aspiration concern

Plan

First 5 minutes and setup

Safety and escalation

Equipment readiness

Removal strategy selection

Ear

Nose

Post removal care

Reexamination

Antibiotics when indicated

Reassessment loop

After each attempt

Stop conditions

Disposition

Level of care criteria

ICU or high acuity

Inpatient admission

Discharge criteria

Follow up timing

ENT follow up

Primary care follow up

Discharge Instructions

Copy discharge instructions

Foreign body removed from the ear or nose today

Medicines

Activity

Return to the emergency department now if

Follow up

References

Guidelines and key sources

Evidence based references

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.