title: A child presenting with a bullet in the middle ear: case report.
abstract: BACKGROUND
  Foreign bodies in the external auditory canal are common in both adults and children. Removal of the foreign body requires skill, but is usually successfully performed in the emergency department. We report a case of a child with a bullet in ear canal which was pushed into the middle ear during an attempt to remove it.
  
  
  METHODS
  A 6-year-old Thai boy went to the community hospital with his parents, who reported that their child had pushed a bullet into his ear. Otoscopic examination revealed a metallic foreign body in his external auditory canal. The first attempt to remove the foreign body failed and the child was referred to an otolaryngologist. We found that the tympanic membrane was ruptured, with granulation tissue in the middle ear and the bullet was located in the hypotympanum. The foreign body was removed via a post-auricular approach.
  
  
  CONCLUSIONS
  Removal of a foreign body from external auditory canal is an essential skill for physicians. Careful removal can prevent further trauma and complications. When the first attempt fails, referral to an otolaryngologist is recommended.
authors.affiliation: Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Patorn
authors.initials: P
authors.lastname: Piromchai
authors.forename: Somchai
authors.initials: S
authors.lastname: Srirompotong
authors.forename: Piyawadee
authors.initials: P
authors.lastname: Lertchanaruengrith
authors.forename: Robert
authors.initials: R
authors.lastname: Mills