Foreign bodies in Otorhinology

Dr Yojana Sharma Assosiate Professor Dept of ENT PSMC, Karamsad

Introduction
‡ Children/ Psychotic/ Mentally retarded accidentally or intentionally lodges objects in the numerous orifices and cavities of head and neck

Signs &Symptoms of FB Nose
± Unilateral nasal discharge since several days ± Purulent discharge tinged with dark blood ± Extremely foul smelling
(These three are strong evidences of Foreign body in the nose)

± Epistaxis

Diagnosis
‡ Anterior Rhinoscopy- after suction clearance under good illumination ‡ Radiographs are of limited value as most of FB are radiolucent

Treatment
‡ Removal of FB under controlled atraumatic conditions in cooperative or anaesthetized patient ‡ Equipments
± Head light of head mirror ± Suction ± Nasal speculum and forceps

Foriegn body in Nasopharynx
‡ This is an uncommon site

‡ Signs and Symptoms± Rhinorrhoea ± Post nasal discharge ± stridor/ snoring

Diagnosis: Lateral X-ray film of nasopharynx may be helpful Treatment: Removal of FB under GA.

Foreign Body in Oropharynx/ Hypopharynx
‡ Sharp objects such as bones pins are prone to become lodged in palatine or lingual tonsils ‡ Dental prosthesis or teeth may become FB after head and neck trauma ‡ In a young child h/o initial gaging episode may be missed

‡ Signs & Symptoms:
± Odynophagia/ Dysphagia/ Drooling of Saliva ± Airway symptoms-Signs of respiratory distress

‡ Diagnosis:
± Many foriegn bodies are directly seen in oropharnyx ± X-ray soft tissue neck lateral view

‡ Treatment:
± ± ± ± Removal under GA if complete obstruction-first aid may be tried Hemlichs Maneuver(subdiaphramatic pressure) if pt. is unconcious or no air with chest wall motion put the patient in supine position with hyperextended neck and mandible held forward this brings tongue forward from post pharyngeal wall and assisting clearing this portion of the airway ± Endotracheal intubation ± Emergency cricothyrotomy/ tracheostomy

‡ Complications:
± Airway obstruction-hypoxia ± Retro/parapharyngeal abcess

FB Oesophagus
‡ Clinical features
± H/o Foreign body ingestion ± Range from none to severe dysphagia, drooling of saliva ± Chronic Oesophageal bodies secondary oedema may compromise airway rarely

‡ Diagnosis
± X-ray chest PA view ± Ba-swallow(small cotton soaked with barium may stick to FB & help to localize

‡ Treatment-Oesophagoscopy under GA and removal

Foreign body Larynx & Trachea
‡ Clinical features:
± H/o choking attack, sometime may not be aware of this ± Stridor-inspiratory(if inspiratory and expiratory FB is in Subglottic region or trachea) ± Voice-hoarseness--glottic region ± Aphonia- complete obstructionEmergencyTreatment:
‡ Hemlich manuvere ‡ Cricothyrotomy/intubation/tracheostomy.

‡ Diagnosis:
± X-ray soft tissue neck lateral view ± X-ray chest PA view

‡ Treatment:
± Endoscopic removal under GA--Direct laryngoscopy of Bronchoscopy by experienced endoscopist

Foreign body in bronchi
‡ H/o aspiration ‡ Signs and symptoms:
± Cough/ fever/ wheezing due to secondary infection ± Unilateral wheezing- decrease or absent breath sounds on side of foreign body

‡ Diagnosis: Xray Chest PA view
± Complete Collapse- mediastinal shift same side with atelactasis ± Partial collapse(Obstructive emphysema)mediastinal shift toward opposite side

‡ Suspect Radiolucent FB with atelactasis or recurrent/ prolonged or migratory pneumonia ‡ Inspiratory and expiratory chest films ‡ Treatment: Bronchoscopy under GA and removal of FB

Foreign body in Ear
‡ It is a frequent site for FB in children ‡ Sign & symptom:
± ± ± ± ± ± small, smooth object(bead, wheat, popcorn) May be multiple/ bilateral Live insects often assymptomatic may cause otitis externa bloody purulent discharge decrease hearing if canal is completely blocked

‡ Diagnosis: otoscopy ‡ Treatment:
± Remove as gently as possible ± Syringing ‡ if space exists between F.B and ear Canal ‡ if TM intact ‡ FB is non hygroscopic ± May be grasped with forcep ± wax hook may be used ± Avoid excessive manuplation in uncooperative patient it may lead to trauma to EAC/ TM/ Ossicles

‡ Refer to ENT surgeon.

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