A separate retrospective study included 275 pediatric patients and found that emergency physicians were successful at removing most of these EAC FBs (86 percent), but the success rate was still less than in the ENT clinic (94 percent).² Complication rates from the ED setting (6 percent) were still higher than the ENT clinic (2.3 percent), but overall were much lower than the prior study. These complications included minor issues such as bleeding or excoriations of the external canal wall. Only 2.3 percent of ED retrievals required procedural sedation. Broadly, rates of successful extraction range from 53–86 percent by emergency physician and the use of procedural sedation varies from about 2 percent to up to 20 percent.^3–7

Conversely, though, there is an occasional study that suggests that we are not great at successfully extracting EAC FBs. A retrospective study of 366 children found the ED/urgent treatment center success rate to be low at 17.5 percent with a complication rate of 22 percent compared to an ENT clinic with a reported successful extraction rate of 94.5 percent.⁷ Interestingly, the authors did not report a complication rate for the ENT clinic and that study makes no mention of the number of patients that warranted procedural sedation.

Which EAC foreign bodies are we the most unsuccessful at retrieving?

Ultimately, it’s the ones that are hard to grasp. A one-year retrospective study of 36 children with EAC FBs identified a higher success rate in graspable objects (64 percent; n=9) compared to non-graspable objects (45 percent; n=9). The complication rate was also much lower in these graspable (14 percent) versus non-graspable (70 percent) cases. Nongraspable objects were described as “smooth-surfaced objects,” but the specific breakdown was not given aside from saying “beads were the most common.” While the number of cases is small, non-graspable FBs appear to decrease the success rate of a successful EAC FB extraction.

Do EAC FBs need to be emergently removed?

Due to the COVID-19 pandemic we gained some data on the timing of EAC FB retrieval. During this time, outpatient ENT appointments were difficult to obtain. A retrospective study of 34 patients including both children and adults aged 2–78 years, evaluated the duration of EAC FB and its relationship to successful removal as well as complications.⁶ The FBs duration ranged from 1–78 days with a mean of 19 days for those who did not require general anesthesia removal and 34 days for those who required removal under general anesthesia. The study did not find that a prolonged duration of EAC FB led to an increase in complications. However, this study is limited in addressing our question as it included both adults and children and had a low number of total patients.