In 1923, Leo Gerstenzang invented the commercial Q-tip after observing his wife attach wads of cotton to the ends of tooth­picks to clean their child’s ears. Since then, Q-tips have become a mainstream household product. In the emergency department, medical Q-tips usually have wooden stems and are longer than commercial ones. This makes them ideal for alternative applications.

Ear Foreign Body

A 6-year-old boy has placed a hard plastic bead in his ear and presents to the ED for care. On examination, you can just barely see the edge of the yellow bead by direct visualization. How can you remove this foreign body as painlessly as possible?

Experientially, you have had poor success with mini-alligator clips and forceps. They often cannot securely grasp beads that are snugly wedged into the ear canal. In addition, they may inadvertently push in the bead even farther.

Trick of the trade: Apply tissue adhesive glue to the wooden end of a long Q-tip. Immediately thereafter, touch the stick to the bead while being careful not to touch the patient’s external ear canal. This should be a painless procedure. After waiting 20-30 seconds to let the glue dry, gently rotate the bead to loosen it from the ear canal wall and any debris. Pull the Q-tip and foreign body out as a unit.

The success of this technique depends both on the type of foreign body in the ear and the child’s ability to stay still. For this approach, the foreign bodies should be smooth, hard-surface objects to which tissue adhesives can adhere. Tissue adhesives adhere poorly to organic foreign bodies such as peas, corn, and cockroaches.

Procedural success also requires that the patient be cooperative and still. Often, playing a cartoon or animation on a TV or mobile device will be a sufficient distraction for the patient during the entire duration of the 30-second procedure.

Visualization of the Eye Despite Swollen Eyelids

Eyelids can become edematous from blunt trauma and local inflammation, making it difficult to visualize the orbit. Using your fingers to retract the eyelids may inadvertently increase ocular pressure and cause additional damage, especially in the setting of a ruptured globe. So, how can you safely retract the eyelids without an eyelid retractor instrument?

Trick of the trade: I thought of this idea when a projector screen was retracting up into a wall-mounted case in a conference room. This same rotational concept can be applied to a patient’s upper eyelids.

Rest the cotton end of the Q-tip on the surface of the upper eyelid just inferior to the bony superior orbital rim. Slowly twirl the Q-tip stem without moving the angle or position of the Q-tip (Figure 1). The texture of the Q-tip cotton tip provides enough traction along the eyelid to “roll” the eyelid out of the way. Often this maneuver is sufficient to allow visualization of the orbit without needing to retract the lower eyelid.

Dr. Lin is a UCSF associate professor of clinical emergency medicine and practices at San Francisco General Hospital. Contact Dr. Lin at Michelle.Lin@emergency.ucsf.edu with comments or suggestions for other “tricks of the trade.”