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Non-Bleeding ENT

Andy Little, DO and Tiffany Proffitt, DO

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The summary below is from an episode of ERcast: Clinical Perspectives

ENT foreign bodies and dental trauma hinge on time-sensitive tissue protection, not just extraction. Ear and nasal button batteries can cause rapid necrosis, while permanent tooth avulsion success falls quickly with extra-alveolar time and proper handling.

Ear and Nasal Foreign Bodies

  • Positioning and visualization: Successful ear foreign body removal starts with lateral recumbent positioning or upright alignment, a strong light source, and every tool laid out before you touch the canal.
  • Insect immobilization first: Live bugs should be drowned with mineral oil or viscous lidocaine for about 15 to 20 minutes before removal, which turns a chaotic extraction into a controlled one.
  • Organic material caution: Rice, bread, corn, and other organic matter should not be irrigated because they swell in the canal; forceps or suction are the safer first-line tools.
  • Cerumen rescue option: When hydrogen peroxide is not enough for cerumen impaction, liquid docusate is a useful softening alternative with a mechanism most emergency clinicians will recognize.
  • Post-extraction canal care: After removal, inspect for canal abrasions or lacerations and treat traumatic otitis externa risk with ofloxacin 0.3% otic drops, 10 drops daily for 7 days.
  • Button battery urgency: Ear and nasal button batteries are true time-critical ENT emergencies because soft-tissue injury can begin within hours; the removal threshold and ENT escalation are worth hearing in the episode.

Dental Trauma Pearls

  • Primary tooth priorities: In children with injured primary teeth, the main job is screening for associated facial trauma and aspiration rather than heroic salvage, since the tooth is destined to exfoliate.
  • Permanent avulsion handling: Handle an avulsed permanent tooth by the crown, rinse it briefly for 10 seconds, and keep it in milk or reimplant promptly; ideal survival is roughly 15 to 30 minutes.
  • Missing tooth red flag: If an avulsed tooth is not accounted for, treat aspiration as a real possibility and get a chest x-ray rather than assuming it was swallowed or lost at the scene.
  • Luxation and extrusion stabilization: Partially displaced permanent teeth can often be gently repositioned and flexibly splinted to a neighboring tooth, with a practical glue-drying trick we share in the chapter.
  • Ellis fracture framing: Ellis class tracks depth of injury: enamel alone is class 1, while dentin or pulp exposure in class 2 or 3 needs sealing, often with calcium hydroxide paste, plus urgent dental follow-up.
  • Aftercare basics: Dental trauma disposition centers on a soft diet, avoiding contact sports, a soft toothbrush, and chlorhexidine 0.1% mouth rinse twice daily for one week.

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References:

  1. Little A. Ear Foreign Body Removal. Published online April 18, 2018. Link
  2. Moungey B. Ear, Nose, and Throat Foreign Bodies. emDOCs.net - Emergency Medicine Education. Published October 23, 2016. Link
  3. Chow Y. Trick of the Trade: Ear foreign body removal with modified suction setup. ALiEM. Published August 25, 2015. Link
  4. Bukowski J. PEM Pearls: Search & Rescue of Ear Foreign Bodies - Picking the Right Tool. ALiEM. Published May 8, 2017. Link
  5. Robinson A. DENTAL TRAUMA GUIDELINES.; 2013. Link
  6. Dailey M. Managing Dental Trauma in the Emergency Department. emDOCs.net - Emergency Medicine Education. Published August 2, 2017. Link
  7. Kelly O. Dental trauma. Don’t Forget The Bubbles. Published online September 26, 2019. doi:10.31440/dftb.20931Bakshi SS, et al.
  8. Long-Term Complications of Button Batteries in the Nose. J Emerg Med. 2016;50(3):485-487. PMID: 26803190

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