Eustachian Tube Foreign Body with Endoscopic-Assisted Surgical Removal

Abstract

Objectives. Foreign bodies of the external and middle ear are not uncommon; however, foreign bodies in the eustachian tube are rare. Here we describe the presentation, imaging, and endoscopic-assisted surgical management of a case of eustachian tube foreign body. Methods. A 34-year-old male was seen for evaluation of foreign body of the left eustachian tube while working with metal at a machine shop. Imaging and surgical management are highlighted and review of available literature regarding foreign bodies of the eustachian tube is presented. Results. A CT scan revealed a foreign body present approximately 1 cm into the bony eustachian tube. The patient underwent middle ear exploration which required endoscopic assistance to adequately visualize the foreign body. The foreign body was unable to be removed and required the creation of a bony tunnel lateral to the eustachian tube for visualization and access to the foreign body. Conclusions. This report presents a rare case of eustachian tube foreign body. Use of the endoscope during the surgical removal greatly enhanced the ease and safety of removal. This report also highlights the importance of ear protection with any machining and welding work.

Transnasal Foreign Body Eustachian Tube Disimpaction: First‐Described Novel Technique

“…2,3 Previous reports have described simple transtympanic approaches, sometimes with the use of endoscopic guidance. 3 However, we demonstrate that in cases with more difficult access, it is possible to push foreign bodies into the middle ear space via a modified transnasal eustachian tube dilation approach, allowing for easier retrieval via a transtympanic approach.…”

“…There is no standard method of retrieval of these foreign bodies, and the literature consists only of case reports. One recent report of a welding injury, resulting in metal slag in the distal aspect of the eustachian tube, described an endoscopic transtympanic retrieval of the foreign body 3 . Of the existing reports, there have been no reports that have retrieved foreign bodies via pushing from the proximal end of the eustachian tube.…”

“…One recent report of a welding injury, resulting in metal slag in the distal aspect of the eustachian tube, described an endoscopic transtympanic retrieval of the foreign body. 3 Of the existing reports, there have been no reports that have retrieved foreign bodies via pushing from the proximal end of the eustachian tube. We present a unique case of metal slag in the eustachian tube, precariously abutting the carotid artery, and a novel technique using a modification to a eustachian tube dilator to push the slag into the middle ear under fluoroscopic guidance.…”

“…Molten slag can reach up to 1000°C, and due to the heat of the slag in an enclosed space, they often cause significant injury and almost complete tympanic membrane perforation in many cases 1 . However, there are very few reports of these injuries resulting in eustachian tube foreign bodies 2,3 …”

An Unusual middle ear foreign body in a welder; our experience

“…3,4 There have been case reports of complex penetrating foreign bodies in difficult anatomical locations such as the Optic nerve head 4 , pre-vertebral muscles 5 , and Eustachian tube. 6 The high velocity and small size of these projectile foreign bodies result in penetration of unusual tissue planes making it difficult to be identified on clinical examination resulting in delayed diagnosis and potentially serious complications. Similarly, undiagnosed foreign bodies in the ear can lead to complications such as recurrent infections, perforations, hearing loss, facial nerve injury, and a lot of discomforts.…”