A 20 yr old male with active squamousal disease in his right ear was advised HRCT B/L temporal bones,which showed an incidental finding of a tiny metallic foreign body 3000 HU in middle of the eustachian tube and soft tissue inflammation all along the eustachian tube.
What would be the ideal way to remove such a foreign body and should it be in the same sitting with the modified radical mastoid surgery that he was being planned for?
Though not really a foreign body in eustachian tube recently we have operated upon a 40 yrs old male patient presented as aural polyp.
Thank you mam. Patient had bilateral active squamosal COM so we have operated the opposite ear . We have given the patient a course of tapering iv steroids for all the inflammation to subside and plan to repeat the scan to look for the metallic fb again.
Will keep you updated . Thank you.
Patient has a small perforation in the anterior quadrant with grade 5 tensa ,all ossicles absent .
Could a magnet be used to remove this foreign body from the perforation. ??
The above foreign body is of 2 mm size and 8 mm away from the opening of the eustachian tube opening on the middle ear side.
Is there any specific magnetic instrument available?
I had once a patient with a metallic foreign body in the Eustachian tube after welding. This metallic foreign body was localised in the isthmus, unfortunately. And there were scars after burning as well (because during welding there are many hot metallic sparks, as You know). Unfortunately, we couldn't remove this foreign body completely, again- because of scars in the tube and arround the foreign body and close relationship of the foreign body with the internal carotid artery, so we decided to leave this foreign body and just put a tympanostomy tube. One year after surgery there was a dry ear, no discharges. Answering Your question about an instrument, I'm suggesting to ask ophthalmologists- they usually have many types of magnetic devices for removal of small metallic foreign bodies from eyes
Hello Dr. Kartik. One suggestion regarding this case you will be able to put sialoendoscope to visualise this foreign body but as it is covered by granulations it will be difficult to reach exactly up to the foreign body.Blind attempts must be avoided as eustachian tube is very close to carotid artery here furthur it is a metallic foreign body so more chances of injury. Magnet :can't say whether it will be useful as foreign body has to be made upof iron. Basket forceps can be attempted but then there should be adequate forceps space. I think good option if you can't retrive foreign body will be mastoidectomy with cartilage tympanoplasty and ventilating tube. Guarded prognosis.
Madam have done a repeat scan of this patient after he had received a course of IV dexa.,it shows the inflammation has subsided. But the foreign body is in the same position.
Even I feel sialoendoscope might be a great tool for this case. Will keep you updated thank you.
Could a wait and watch policy or leaving behind the foreign body and doing an aerotympanoplasty be a risky option? Could the foreign body migrate or cause erosion of the bony wall of the carotid? A scary thought !
Almost a year has passed.. this patient's recent scan showed a change in intensity to 2500 HU so the radiologist advised mri. Mri scan shows no artefact. Hence they conclude that it is not metal but a sclerotic bone piece. Could it b a fallen ossicle? !
As the patient has grade 5 retracted pars tensa with no ossicles. N no lateral scutum. Endoscopic view is as below.
What is your idea of management now ?
It was a bony foreign body (?eroded ossicle)..extremely difficult to remove. Patient has undergone canal wall down mastoidectomy followed by removal of this foreign body. We have placed a conceal cartilage graft with a Goode's t-tube in it, as the mucosa in the area of the eustachian tube opening was traumatised during manipulation.
Will update regarding the results.Thank you all for your help.
please let me know if any one has ever had a eustachian tube foreign body like this.
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