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Destructive Otologic Foreign Body: Dangers of the Expanding Bead

Megan Sterling, DO1,2; Pamela Mudd, MD, MBA1
[+] Author Affiliations
1Department of Otolaryngology, Children’s National Medical Center, Washington, DC
2Department of Otolaryngology, Walter Reed National Military Medical Center, Bethesda, Maryland
JAMA Otolaryngol Head Neck Surg. 2016;142(9):919-920. doi:10.1001/jamaoto.2016.1870.
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This case series examines the dangers of superabsorbent polymer beads to otologic structures in the external auditory canal.

Foreign bodies of the external auditory canal (EAC-FB) are a common presentation to the emergency department (ED), with an estimated 280 000 visits from 2008 to 2012 in the United States.1 Cases are evaluated and treated with irrigation, suction, or surgical instrumentation. Otic drops are given if there is secondary canal trauma or inability to remove EAC-FB.2 One-third of patients require otolaryngology referral; 75% of these referrals consist of round or firm objects best removed under otomicroscopy and are seen on a less urgent basis. Expedient evaluation is indicated in cases associated with infection secondary to canal trauma from unsuccessful removal.3 Urgent referral is indicated for materials with potential for destruction, such as button batteries. Two patients were diagnosed with an EAC-FB that expanded within the ear canal leading to tympanic membrane (TM) perforation, ossicular erosion, and in a prolonged case, otic capsule erosion resulting in permanent auditory and vestibular loss. The FB in each case was identified as a water-expanding bead marketed as a children’s toy.

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Figure 1.
Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of the Destructive Otologic Foreign Body

A, Axial CT images of the right temporal bone at initial presentation. Thickening of soft tissue within the external auditory canal (EAC) (asterisk). B, Axial CT images of the right temporal bone 10 weeks after initial presentation. There is erosion of the tympanic plate and anterior mastoid. A linear hyperdensity in the EAC (arrowhead) likely represents a displaced fragment of the tympanic plate. Axial (C) and Coronal (D) fat-saturated T2-weighted MRI of the same patient prior to biopsy. Both images demonstrate a 9.0 mm T2-hyperintense, spherical lesion suspicious for a foreign body and is found in the expected location of the middle ear cavity. The EAC measured diameter is 5.9-mm, indicating the foreign body had expanded after insertion. Imaging was obtained 10 weeks after initial presentation.

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Figure 2.
Store-bought Superabsorbant Polymer Beads Before and After Exposure to Liquid Medium

Water beads or jelly beads are water expandable toys marketed to children for play, arts and crafts, and sensory play as well. When small (0.1-0.2 mm) the bead is hard and once exposed to water or liquid the bead grows to about 9 mm in diameter, becomes gel-like and breaks apart somewhat easily.

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