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Foreign Body In Ear Or NoseAPPROACH

ENT, EYE, DENTAL · 19 SECTIONS

⚲

412 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Dysphagia And Odynophagia Throat Pain Ear Pain Foreign Body In Ear Or Nose Vision Loss Complaint Flashes And Floaters Atraumatic Eye Pain Red Eye Dental Abscess Concern Post Extraction Pain And Complications

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx59

Presenting context

›Foreign body history

›Location

›External auditory canal

›Nasal cavity

›Object description

›Button battery

›Magnet

›Food

›Bead

›Insect

›Sharp object

›Witnessed insertion

›Yes

›No

›Time since insertion

›Minutes to hours

›More than 24 hours

OPQRST

›Onset

›Sudden

›Unclear timing

›Provocation and palliation

›Worse with manipulation

›Worse with swallowing

›Improved after partial removal attempt

›Quality

›Foreign body sensation

02Alarm Features/alarm29

Immediate threats

›Airway risk

›Stridor

›Respiratory distress

›Drooling

›Inability to handle secretions

›Button battery exposure

›Suspected or confirmed button battery

›Severe pain out of proportion

›Bloody nasal discharge

›Magnet exposure

›Multiple magnets

›Magnet plus metallic object

›Uncontrolled bleeding

›Persistent epistaxis despite pressure

›Hemodynamic instability

High risk objects and scenarios

›Sharp or penetrating object

›Fishhook

›Glass

›Caustic or expanding material

›Superabsorbent polymer bead

›Vegetable matter in ear

›Infection or complication concern

›Fever

›Facial swelling

›Periorbital swelling

03Medications/meds37

Current and recent medications

›Bleeding risk medications

›Anticoagulants

›Antiplatelets

›Immunosuppression

›Systemic corticosteroids

›Biologics

Procedural medications

›Topical anesthesia options

›Lidocaine topical

›2 percent to 4 percent

›Avoid if tympanic membrane perforation concern for ototoxic mixtures

›LET gel for anterior nares

›Local protocol dependent

›Topical vasoconstrictors for nares

›Oxymetazoline intranasal

›1 to 2 sprays per nostril

›Avoid in infants where advised by local protocol

›Phenylephrine intranasal

›Local protocol dependent concentration

›Hypertension and tachycardia risk

Sedation and analgesia

›Analgesia

›Acetaminophen oral

›15 mg per kg

›Maximum adult 1000 mg per dose

›Ibuprofen oral

›10 mg per kg

04Diet/diet6

NPO and aspiration considerations

›Recent oral intake

›Last solids timing

›Last clear liquids timing

›Aspiration risk modifiers

›Active vomiting

›Significant nasal bleeding

05Review of Systems/ros13

System screen

›Constitutional

›Fever

›Malaise

›HEENT

›Visual changes

›Facial pain

›Dental pain

›Respiratory

›Cough

›Wheeze

›Neurologic

›Headache

›Syncope

06Collateral History and Family History/chafh9

Collateral sources

›Source and reliability

›Parent or caregiver report

›Witnessed insertion report

Family and household context

›Household exposures

›Button batteries accessible

›Small magnets accessible

›Supervision reliability

›Concern for repeat insertion

›Safety planning needs

07Risk Factors/rf15

Patient factors

›Pediatrics

›Age under 5 years

›Developmental delay

›Bleeding risk

›Anticoagulation

›Platelet dysfunction

›Infection risk

›Diabetes mellitus (E11.9)

›Immunocompromised state

Object related risks

›Button battery

›Liquefaction necrosis risk within hours

›Septal perforation risk

›Magnet

›Pressure necrosis risk

›Septal necrosis risk

08Differential Diagnosis/ddx31

Life threatening

›Airway foreign body aspiration (T17.2)

›Choking episode

›Persistent cough

›Unilateral wheeze

›Button battery injury

›Nasal mucosal necrosis

›Septal perforation

›Severe epistaxis with instability

›Ongoing brisk bleeding

›Syncope

Common

›Foreign body in external ear (T16)

›Conductive hearing loss

›Otalgia

›Foreign body in nose (T17.1)

›Unilateral foul discharge

›Unilateral obstruction

›Otitis externa (H60.9)

›Tragal tenderness

›Canal edema

›Rhinitis and sinusitis (J32.9)

›Bilateral symptoms

›Fever with sinus tenderness

Less common

›Tympanic membrane perforation (H72.90)

›Sudden pain then relief

›Hearing change

09Past Medical History/pmh10

Relevant conditions

›ENT history

›Prior foreign bodies

›Recurrent otitis media

›Tympanostomy tubes

›Coagulation and bleeding history

›Known bleeding disorder

›Prior severe epistaxis

›Sedation risk history

›Prior airway complications with sedation

›Obstructive sleep apnea (G47.33)

10Physical Exam/exam28

Initial survey and vitals

›Stability and monitoring needs

›Work of breathing

›Oxygen saturation

›Perfusion

›Capillary refill

›Heart rate pattern

Ear exam

›Otoscopy and auricle

›Object type and location

›Canal edema

›Canal laceration

›Bleeding

›Tympanic membrane visualization

›Vestibular and neuro symptoms

›Nystagmus

›Ataxia

Nasal exam

›External nose and septum

›Visible foreign body

›Mucosal ulceration

›Foul discharge

›Bleeding assessment

›Anterior source visible

›Posterior bleed concern

Oropharynx and airway

›Airway and secretion handling

›Drooling

11Lab Studies/labs9

When labs are useful

›Bleeding concern

›Hemoglobin trend if significant bleeding

›Coagulation studies if on anticoagulants or unknown coagulopathy

›Infection concern

›CBC if systemic toxicity

›CRP local protocol dependent

Pitfalls and limits

›Normal labs do not exclude mucosal necrosis from button battery

›Time since insertion more informative than labs

›Exam findings drive urgency

12Imaging/img19

Scoring Systems

›Not routinely indicated

›No validated scoring system for ear or nasal foreign body

›Risk stratification driven by object type and exam

MRI

›Generally not indicated

›Avoid if possible magnet foreign body concern

›Specialty guided for complications

›Indications

›Suspected deep tissue complication

›Orbital or facial cellulitis concern

›Nonvisualized sharp object with ongoing symptoms

›Key cautions

›Radiation exposure

›Contrast allergy and kidney risk if contrast used

Ultrasound

›Limited role

›Soft tissue foreign body outside canal or nares

›Abscess evaluation if swelling

›Pitfalls

›Air artifact limits nasal cavity evaluation

›Operator dependence

13Special Tests/spec29

Bedside ENT techniques

›Visualization aids

›Headlamp or focused light

›Otoscope speculum selection

›Ear foreign body removal options

›Alligator forceps for graspable objects

›Curette or hook for round objects

›Suction for smooth objects

›Magnet for metallic objects

›Irrigation for nonorganic objects

›Contraindicated with button battery

›Contraindicated with vegetable matter

›Contraindicated with tympanic membrane perforation concern

›Nasal foreign body removal options

›Positive pressure technique

›Caregiver mouth to mouth puff with contralateral occlusion

›Bag valve mask mouth puff with contralateral occlusion

›Instrumentation

›Suction catheter

›Bayonet forceps for graspable objects

›Balloon catheter behind object

›Insect in ear canal

›Immobilization with topical lidocaine

›Removal after immobilization

Consultation triggers

›ENT consultation

›Button battery in ear or nose

›Magnet foreign body with mucosal injury

14ECG/ecg6

When ECG is relevant

›Not routinely indicated

›Consider only if sedation planned with risk factors

›Consider if significant sympathomimetic exposure from topical agents in high risk patients

Sedation related monitoring

›Baseline rhythm documentation

›Known congenital heart disease

›Known arrhythmia history

15Assessment/ax17

Problem representation

›Foreign body location and risk category

›External ear canal foreign body (T16)

›High risk object

›Low risk object

›Nasal foreign body (T17.1)

›High risk object

›Low risk object

Complications to rule out

›Ear related

›Tympanic membrane perforation (H72.90)

›Otitis externa (H60.9)

›Nasal related

›Mucosal necrosis

›Septal injury

›Sinusitis (J32.9)

›Aspiration concern

›Airway foreign body aspiration (T17.2)

›Need for chest evaluation

16Plan/plan46

Differential Management

›!Nasal foreign body→

First 5 minutes and setup

›Safety and escalation

›Airway concern triggers immediate resuscitation response

›Button battery triggers immediate removal pathway

›Equipment readiness

›Suction setup

›Light source

›Appropriate specula

›Forceps and hooks

Removal strategy selection

›Ear

›Graspable object

›Forceps

›Minimize canal trauma

›Smooth round object

›Suction or hook

›Consider sedation if repeated movement

›Irrigation candidate

›No battery

›No vegetable matter

›Tympanic membrane intact or confidently visualized

›Nose

›First line

›Positive pressure technique

›Topical vasoconstrictor if swollen mucosa

›Second line

17Disposition/dispo21

Level of care criteria

›ICU or high acuity

›Airway compromise

›Ongoing significant bleeding with instability

›Sedation complication

›Inpatient admission

›Button battery injury with significant necrosis

›Facial or periorbital cellulitis

›Concern for retained sharp foreign body needing operative removal

›Discharge criteria

›Foreign body removed

›No airway concern

›Hemostasis achieved

›Normal or stable exam findings

›Reliable caregiver supervision for pediatrics

Follow up timing

›ENT follow up

›Button battery exposure within 24 hours

›Suspected tympanic membrane injury

›Persistent symptoms after removal

›Primary care follow up

›Minor mucosal trauma

›Counseling on prevention and safe storage

18Discharge Instructions/di21

Copy discharge instructions

›Foreign body removed from the ear or nose today

›Mild soreness or a small amount of spotting can happen for 24 to 48 hours

›Avoid putting anything into the ear or nose

›Medicines

›Use acetaminophen or ibuprofen as directed for pain

›Use prescribed drops or antibiotics exactly as instructed if provided

›Activity

›Avoid swimming until ear pain and drainage are gone

›Do not blow the nose forcefully for 24 hours if there was bleeding

›Return to the emergency department now if

›Trouble breathing

›Worsening pain

›Fever

›Increasing redness or swelling of the face or around the eye

›Heavy bleeding that does not stop with pressure

›Persistent bad smelling discharge from one nostril

›New hearing loss

›Dizziness or vomiting

›Follow up

›Follow up with ENT if advised

›Follow up with primary care within 2 to 3 days if symptoms persist

19References/r7

Guidelines and key sources

›Evidence based references

›American Academy of Pediatrics button battery injury guidance 2021

›National Capital Poison Center button battery guideline updates 2024

›American Academy of Otolaryngology Head and Neck Surgery clinical resources on ear and nasal foreign bodies

›ACEP clinical policy procedural sedation in the emergency department 2014

›UpToDate foreign bodies of the ear and nose topic review updated regularly

›Project instructions source

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

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

Foreign Body In Ear Or NoseAPPROACH

ENT, EYE, DENTAL · 19 SECTIONS

⚲

412 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx59

Presenting context

›Foreign body history

›Location

›External auditory canal

›Nasal cavity

›Object description

›Button battery

›Magnet

›Food

›Bead

›Insect

›Sharp object

›Witnessed insertion

›Yes

›No

›Time since insertion

›Minutes to hours

›More than 24 hours

OPQRST

›Onset

›Sudden

›Unclear timing

›Provocation and palliation

›Worse with manipulation

›Worse with swallowing

›Improved after partial removal attempt

›Quality

›Foreign body sensation

02Alarm Features/alarm29

Immediate threats

›Airway risk

›Stridor

›Respiratory distress

›Drooling

›Inability to handle secretions

›Button battery exposure

›Suspected or confirmed button battery

›Severe pain out of proportion

›Bloody nasal discharge

›Magnet exposure

›Multiple magnets

›Magnet plus metallic object

›Uncontrolled bleeding

›Persistent epistaxis despite pressure

›Hemodynamic instability

High risk objects and scenarios

›Sharp or penetrating object

›Fishhook

›Glass

›Caustic or expanding material

›Superabsorbent polymer bead

›Vegetable matter in ear

›Infection or complication concern

›Fever

›Facial swelling

›Periorbital swelling

03Medications/meds37

Current and recent medications

›Bleeding risk medications

›Anticoagulants

›Antiplatelets

›Immunosuppression

›Systemic corticosteroids

›Biologics

Procedural medications

›Topical anesthesia options

›Lidocaine topical

›2 percent to 4 percent

›Avoid if tympanic membrane perforation concern for ototoxic mixtures

›LET gel for anterior nares

›Local protocol dependent

›Topical vasoconstrictors for nares

›Oxymetazoline intranasal

›1 to 2 sprays per nostril

›Avoid in infants where advised by local protocol

›Phenylephrine intranasal

›Local protocol dependent concentration

›Hypertension and tachycardia risk

Sedation and analgesia

›Analgesia

›Acetaminophen oral

›15 mg per kg

›Maximum adult 1000 mg per dose

›Ibuprofen oral

›10 mg per kg

04Diet/diet6

NPO and aspiration considerations

›Recent oral intake

›Last solids timing

›Last clear liquids timing

›Aspiration risk modifiers

›Active vomiting

›Significant nasal bleeding

05Review of Systems/ros13

System screen

›Constitutional

›Fever

›Malaise

›HEENT

›Visual changes

›Facial pain

›Dental pain

›Respiratory

›Cough

›Wheeze

›Neurologic

›Headache

›Syncope

06Collateral History and Family History/chafh9

Collateral sources

›Source and reliability

›Parent or caregiver report

›Witnessed insertion report

Family and household context

›Household exposures

›Button batteries accessible

›Small magnets accessible

›Supervision reliability

›Concern for repeat insertion

›Safety planning needs

07Risk Factors/rf15

Patient factors

›Pediatrics

›Age under 5 years

›Developmental delay

›Bleeding risk

›Anticoagulation

›Platelet dysfunction

›Infection risk

›Diabetes mellitus (E11.9)

›Immunocompromised state

Object related risks

›Button battery

›Liquefaction necrosis risk within hours

›Septal perforation risk

›Magnet

›Pressure necrosis risk

›Septal necrosis risk

08Differential Diagnosis/ddx31

Life threatening

›Airway foreign body aspiration (T17.2)

›Choking episode

›Persistent cough

›Unilateral wheeze

›Button battery injury

›Nasal mucosal necrosis

›Septal perforation

›Severe epistaxis with instability

›Ongoing brisk bleeding

›Syncope

Common

›Foreign body in external ear (T16)

›Conductive hearing loss

›Otalgia

›Foreign body in nose (T17.1)

›Unilateral foul discharge

›Unilateral obstruction

›Otitis externa (H60.9)

›Tragal tenderness

›Canal edema

›Rhinitis and sinusitis (J32.9)

›Bilateral symptoms

›Fever with sinus tenderness

Less common

›Tympanic membrane perforation (H72.90)

›Sudden pain then relief

›Hearing change

09Past Medical History/pmh10

Relevant conditions

›ENT history

›Prior foreign bodies

›Recurrent otitis media

›Tympanostomy tubes

›Coagulation and bleeding history

›Known bleeding disorder

›Prior severe epistaxis

›Sedation risk history

›Prior airway complications with sedation

›Obstructive sleep apnea (G47.33)

10Physical Exam/exam28

Initial survey and vitals

›Stability and monitoring needs

›Work of breathing

›Oxygen saturation

›Perfusion

›Capillary refill

›Heart rate pattern

Ear exam

›Otoscopy and auricle

›Object type and location

›Canal edema

›Canal laceration

›Bleeding

›Tympanic membrane visualization

›Vestibular and neuro symptoms

›Nystagmus

›Ataxia

Nasal exam

›External nose and septum

›Visible foreign body

›Mucosal ulceration

›Foul discharge

›Bleeding assessment

›Anterior source visible

›Posterior bleed concern

Oropharynx and airway

›Airway and secretion handling

›Drooling

11Lab Studies/labs9

When labs are useful

›Bleeding concern

›Hemoglobin trend if significant bleeding

›Coagulation studies if on anticoagulants or unknown coagulopathy

›Infection concern

›CBC if systemic toxicity

›CRP local protocol dependent

Pitfalls and limits

›Normal labs do not exclude mucosal necrosis from button battery

›Time since insertion more informative than labs

›Exam findings drive urgency

12Imaging/img19

Scoring Systems

›Not routinely indicated

›No validated scoring system for ear or nasal foreign body

›Risk stratification driven by object type and exam

MRI

›Generally not indicated

›Avoid if possible magnet foreign body concern

›Specialty guided for complications

›Indications

›Suspected deep tissue complication

›Orbital or facial cellulitis concern

›Nonvisualized sharp object with ongoing symptoms

›Key cautions

›Radiation exposure

›Contrast allergy and kidney risk if contrast used

Ultrasound

›Limited role

›Soft tissue foreign body outside canal or nares

›Abscess evaluation if swelling

›Pitfalls

›Air artifact limits nasal cavity evaluation

›Operator dependence

13Special Tests/spec29

Bedside ENT techniques

›Visualization aids

›Headlamp or focused light

›Otoscope speculum selection

›Ear foreign body removal options

›Alligator forceps for graspable objects

›Curette or hook for round objects

›Suction for smooth objects

›Magnet for metallic objects

›Irrigation for nonorganic objects

›Contraindicated with button battery

›Contraindicated with vegetable matter

›Contraindicated with tympanic membrane perforation concern

›Nasal foreign body removal options

›Positive pressure technique

›Caregiver mouth to mouth puff with contralateral occlusion

›Bag valve mask mouth puff with contralateral occlusion

›Instrumentation

›Suction catheter

›Bayonet forceps for graspable objects

›Balloon catheter behind object

›Insect in ear canal

›Immobilization with topical lidocaine

›Removal after immobilization

Consultation triggers

›ENT consultation

›Button battery in ear or nose

›Magnet foreign body with mucosal injury

14ECG/ecg6

When ECG is relevant

›Not routinely indicated

›Consider only if sedation planned with risk factors

›Consider if significant sympathomimetic exposure from topical agents in high risk patients

Sedation related monitoring

›Baseline rhythm documentation

›Known congenital heart disease

›Known arrhythmia history

15Assessment/ax17

Problem representation

›Foreign body location and risk category

›External ear canal foreign body (T16)

›High risk object

›Low risk object

›Nasal foreign body (T17.1)

›High risk object

›Low risk object

Complications to rule out

›Ear related

›Tympanic membrane perforation (H72.90)

›Otitis externa (H60.9)

›Nasal related

›Mucosal necrosis

›Septal injury

›Sinusitis (J32.9)

›Aspiration concern

›Airway foreign body aspiration (T17.2)

›Need for chest evaluation

16Plan/plan46

Differential Management

›!Nasal foreign body→

First 5 minutes and setup

›Safety and escalation

›Airway concern triggers immediate resuscitation response

›Button battery triggers immediate removal pathway

›Equipment readiness

›Suction setup

›Light source

›Appropriate specula

›Forceps and hooks

Removal strategy selection

›Ear

›Graspable object

›Forceps

›Minimize canal trauma

›Smooth round object

›Suction or hook

›Consider sedation if repeated movement

›Irrigation candidate

›No battery

›No vegetable matter

›Tympanic membrane intact or confidently visualized

›Nose

›First line

›Positive pressure technique

›Topical vasoconstrictor if swollen mucosa

›Second line

17Disposition/dispo21

Level of care criteria

›ICU or high acuity

›Airway compromise

›Ongoing significant bleeding with instability

›Sedation complication

›Inpatient admission

›Button battery injury with significant necrosis

›Facial or periorbital cellulitis

›Concern for retained sharp foreign body needing operative removal

›Discharge criteria

›Foreign body removed

›No airway concern

›Hemostasis achieved

›Normal or stable exam findings

›Reliable caregiver supervision for pediatrics

Follow up timing

›ENT follow up

›Button battery exposure within 24 hours

›Suspected tympanic membrane injury

›Persistent symptoms after removal

›Primary care follow up

›Minor mucosal trauma

›Counseling on prevention and safe storage

18Discharge Instructions/di21

Copy discharge instructions

›Foreign body removed from the ear or nose today

›Mild soreness or a small amount of spotting can happen for 24 to 48 hours

›Avoid putting anything into the ear or nose

›Medicines

›Use acetaminophen or ibuprofen as directed for pain

›Use prescribed drops or antibiotics exactly as instructed if provided

›Activity

›Avoid swimming until ear pain and drainage are gone

›Do not blow the nose forcefully for 24 hours if there was bleeding

›Return to the emergency department now if

›Trouble breathing

›Worsening pain

›Fever

›Increasing redness or swelling of the face or around the eye

›Heavy bleeding that does not stop with pressure

›Persistent bad smelling discharge from one nostril

›New hearing loss

›Dizziness or vomiting

›Follow up

›Follow up with ENT if advised

›Follow up with primary care within 2 to 3 days if symptoms persist

19References/r7

Guidelines and key sources

›Evidence based references

›American Academy of Pediatrics button battery injury guidance 2021

›National Capital Poison Center button battery guideline updates 2024

›American Academy of Otolaryngology Head and Neck Surgery clinical resources on ear and nasal foreign bodies

›ACEP clinical policy procedural sedation in the emergency department 2014

›UpToDate foreign bodies of the ear and nose topic review updated regularly

›Project instructions source

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

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