Case Report
Krazy Glue® in the ear: A case report of child abuse

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Abstract

Krazy Glue® or cyanoacrylate glue is an acrylic resin that polymerizes in less than a minute when in contact with moisture or water. We present a case of a one month old referred to our tertiary pediatric otolaryngology clinic from an outside emergency department with a history of application of cyanoacrylate glue in the external ear canals. This report presents the management of this case along with the medical and legal outcomes surrounding this case of child abuse.

Introduction

Ethyl cyanoacrylate (EC) is an acrylic resin, colorless liquid with low viscosity that polymerizes rapidly (less than a minute) in the presence of water. A normal bond reaches full strength in 2 h and is waterproof. Removal of this substance when applied to the body may require solvents which are toxic and harmful to humans [1]. EC is the main component of cyanoacrylate glues which have a wide variety of interchangeable trade names [2].

Cyanoacrylate glues are soluble in acetone, methyl ethyl ketone, nitromethane, and methylene chloride [3]. There are few steps recommended to remove cyanoacrylate from the skin [[2], [3], [4]]:

  • 1.

    Soak the skin in warm soapy water as soon as possible. This will aim to soften the glue.

  • 2.

    Use an acetone nail polish remover. Acetone softens cyanoacrylate by weakening its bonds and can be applied directly onto the area with the aim of the adhesive to be peeled away.

  • 3.

    On sensitive skin, vegetable-based margarine can be rubbed onto the glue before using the acetone or alternatively a diluted acetone (1:10) as in our case may be enough.

  • 4.

    Never use a cotton swab as cotton can react violently with the cyanoacrylate. There is evidence that when placed in contact with cotton and other fabrics, cyanoacrylate glue can cause a rapid exothermic reaction and therefore result in a burn injury [2,5].

  • 5.

    Once the area has dried, a pumice stone or a compress soaked in warm water can be used to remove the glue, taking care not to remove skin [5].

If the cyanoacrylate is deposited in the external ear canal's (EAC's) then the individual should be referred to a Otolaryngology outpatient clinic for review. The Otolaryngologist will be able to assess the status of the injury and whether or not the removal will require surgical intervention. Acetone is a ketone and the ototoxicity of acetone (identified as dimethyl formaldehyde or dimethyl ketone) has been documented in a prospective cohort study of aluminum workers exposed to organic solvents and suggests that occupational exposure to organic solvent mixtures is a risk factor for high frequency hearing loss (OR = 1.87, p = 0.004) [1]. This case report illustrates the non-accidental application of cyanoacrylate glue to a child's external ear canals bilaterally and the subsequent successful removal.

Section snippets

Case presentation

A 1-month old male presented to a general hospital emergency department with a history of non-accidental application of cyanoacrylate (trade name: Krazy Glue®) in the external pinna and external auditory canals (EAC) bilaterally. His parents reported the patient was left in the care of the child's adult aunt while the mother was attending a post-delivery medical appointment. Limited success was made with attempts to remove the glue with warm compresses in the emergency department and he was

Discussion

Kemp first penned the term “battered child syndrome” in 1962 and refers to child abuse and neglect [6]. Child abuse has been defined as a recent act or failure to act resulting in imminent risk of serious harm, death, serious physical or emotional harm, sexual abuse, or exploitation of a child (a person less than the age of 18 years) by a parent or caretaker who is responsible for the child's wellbeing [[6], [7], [8]]. There are four forms of child abuse: physical, emotional, sexual and child

Conclusion

In this case presentation cyanoacrylate glue was removed from the external ear canal safely using diluted acetone which did not damage the patient's hearing. Installation of cyanoacrylate glue into a child's external ear canals may be accidental or of malicious intent. The information presented in this report demonstrate a removal process which did not harm the external ear canal or hearing abilities for a victim of installation with malicious intent.

Conflicts of interest

The authors of this manuscript report no conflicts of interest.

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© 2018 Published by Elsevier B.V.