Last reviewed: March 2026
Contents
MDM Templates
Ear Foreign Body — Successful Removal
Patient presents with a foreign body in the *** ear. No associated pain, hearing loss, or discharge at presentation. No evidence of infection or injury to the external auditory canal or tympanic membrane.
Foreign body was removed successfully on first attempt per procedure note. Post-removal inspection demonstrates an intact tympanic membrane, clear canal without residual foreign body, and no significant trauma.
Plan: Ciprofloxacin otic drops prophylactically for 5 days to prevent otitis externa.
Disposition: Discharge with PCP follow-up in 48–72 hours. Return precautions for ear pain, discharge, or hearing loss.
Nasal Foreign Body — Successful Removal
Patient presents with a foreign body in the *** nare. No evidence of secondary infection. No foul-smelling unilateral nasal discharge (which would suggest prolonged retention).
Foreign body was removed successfully on first attempt per procedure note. Post-removal inspection demonstrates an intact nasal septum without septal hematoma and no residual foreign body.
Plan: No prophylactic medications needed.
Disposition: Discharge with PCP follow-up if symptoms develop. Return precautions for nasal obstruction, unilateral discharge, or pain.
Foreign Body — Unsuccessful Removal
Patient presents with a foreign body in the ***. After appropriate attempts at removal, the foreign body could not be safely extracted in the ED setting due to ***.
Given failed removal, I have considered the risk of infection, tissue necrosis (especially with organic material or button batteries), and migration. No signs of current complication.
Plan: Ciprofloxacin otic drops for prophylaxis (if ear). Analgesics as needed.
ENT referral arranged for removal under direct visualization or sedation within 24–48 hours.
Disposition: Discharge with strict ENT follow-up. Return precautions for pain, swelling, discharge, or fever.
Button Battery Foreign Body
Patient presents with a button battery lodged in the ***. This is a time-sensitive emergency due to the risk of liquefactive necrosis from electrical current and alkaline leakage. No current signs of mucosal necrosis, perforation, or secondary infection.
Button batteries begin causing tissue damage within hours — nasal septal perforation can occur within 24 hours. Emergent removal is required.
Plan: Emergent removal attempted. No topical vasoconstrictors (nasal sprays like oxymetazoline) applied — these may create an electrical current with the battery and worsen injury.
If removal unsuccessful: ENT consulted emergently for removal under sedation or in the OR.
Disposition: Per ENT if removal complicated. If removed successfully, discharge with close follow-up for mucosal healing assessment.
Procedure Notes
Ear Foreign Body Removal
Location: *** ear
Time Out: Correct patient, correct procedure confirmed
Anesthesia: None required (or: topical lidocaine drops instilled)
Approach: Direct visualization with otoscope. Patient positioned supine with head turned
Methods: *** (Katz extractor / alligator forceps / irrigation / suction tip) used to remove the foreign body from the external auditory canal
Exploration: Post-removal inspection demonstrates intact tympanic membrane, clear canal, no residual foreign body
Complications: None. Patient tolerated procedure well. No diminished hearing
Nasal Foreign Body Removal
Location: *** nare
Time Out: Correct patient, correct procedure confirmed
Anesthesia: None required (or: topical oxymetazoline + lidocaine applied)
Approach: Patient seated upright. Nasal cavity examined with headlamp and nasal speculum
Methods: *** (Katz extractor / positive pressure “mother’s kiss” / alligator forceps / Fogarty catheter) used to remove the foreign body from the nare
Exploration: Post-removal inspection demonstrates intact nasal septum, no septal hematoma, no residual foreign body
Complications: None. Patient tolerated procedure well
Clinical Education
Removal Techniques
You typically get one good attempt — especially in children. Failed attempts cause pain, swelling, bleeding, and loss of patient cooperation, making subsequent attempts harder. Choose your technique based on the object type and location before starting.[1]
| Technique | Best For | Notes |
| Katz extractor / curette | Smooth, round objects | Pass behind the object and pull forward |
| Alligator forceps | Irregular, graspable objects | Risk of pushing deeper if not careful |
| Irrigation (ear only) | Small, non-organic objects | Contraindicated if TM perforation or organic material (swells) |
| Positive pressure (“mother’s kiss”) | Nasal FBs in cooperative children | Parent occludes unaffected nare, gives a short puff into child’s mouth |
| Fogarty catheter | Nasal FBs behind the object | Pass beyond object, inflate balloon, pull anteriorly |
| Cyanoacrylate (glue on stick) | Smooth objects with a flat surface | Apply glue to wooden stick, touch to object, wait 60 seconds, pull |
Button Battery Pearls
Button batteries are a true emergency regardless of location. The battery generates a current that causes electrolysis of tissue fluid, producing sodium hydroxide (lye) at the negative pole. This causes liquefactive necrosis. Mucosal ulceration begins within 3 hours. Nasal septal perforation is expected within 24 hours of a battery lodged against the septum.[2]
Do NOT apply nasal decongestant sprays or saline irrigation to a battery in the nose — the liquid creates an electrolyte solution that accelerates the electrical current and worsens tissue damage. Remove the battery dry.[2]
After removal: inspect the mucosa carefully for evidence of necrosis, ulceration, or perforation. Close ENT follow-up is mandatory even after successful removal to monitor healing.
Live Insect Pearls
Kill the insect before removal. A live insect in the ear canal is extremely distressing and painful. Instill mineral oil, 2% lidocaine solution, or microscope immersion oil to drown or immobilize the insect, then remove with alligator forceps or irrigation. Do not attempt forceps removal on a live, moving insect — you’ll push it deeper and risk TM injury.[1]
Complications
Ear: canal abrasion, TM perforation, otitis externa. Prophylactic ciprofloxacin otic drops after removal are reasonable standard practice. If TM ruptured during removal, prescribe amoxicillin otic drops as prophylaxis for otitis media and refer to ENT.[1]
Nose: epistaxis, septal hematoma (always check for this — untreated septal hematoma causes septal necrosis and saddle nose deformity), aspiration (rare but possible if the object is pushed posteriorly), and secondary sinusitis from prolonged retention.[1]
Disposition
Successful removal, no complications: discharge with PCP follow-up. Button battery removed: ENT follow-up in 24–48 hours to assess mucosa. Failed removal or complicated extraction: ENT consultation for removal under sedation. TM perforation or septal hematoma: ENT follow-up within 24 hours.[1]
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