Foreign bodies:

ENT
Nandita Venkatesh
88
Foreign bodies:
Ear
 TYPES
Non living:
• Children- piece of paper or sponge, grain seeds (rice, wheat, maize),
slate pencil, piece of chalk or metallic ball bearings.
• Adults-broken end of matchstick, cotton swabs, vegetable foreign bodies
(they tend to swell up and get tightly impacted in the ear canal and can
even suppurate)

Living:
• Flying or crawling insects like mosquitoes, beetles, cockroach and ant
may enter the ear canal and cause intense irritation and pain
 Methods of removal
Non living
(i) Forceps removal - Soft and irregular foreign bodies like a piece of paper,
swab or a piece of sponge
(ii) Syringing - Seed grains and smooth
objects
(iii) Suction
(iv) Microscopic removal with special instruments
v)Post-aural approach - can be used for foreign bodies impacted in deep meatus,
medial to the isthmus or if they have been pushed into the middle ear.
 Living
• The insect is killed by instilling mineral oil, spirit or chloroform
water.
• The insect can then be removed- syringing, forceps removal,
suction or microscopic removal
Foreign bodies:
Nose
 AETIOLOGY
• mostly seen in children

• Pieces of paper, chalk, button, pebbles,seeds, cotton or swabs may be

accidentally left in the nose
 CLINICAL
FEATURES
• Unilateral nasal discharge
• foul smelling
• bloodstained
DIFFERENTIAL
• rhinolith,
DIAGNOSIS
•
•
nasal diphtheria,
nasal myiasis
• acute or chronic unilateral sinusitis
 TREATMENT
• Forceps- Pieces of paper or cotton swabs
• Blunt hook- Rounded foreign bodies. Eustachian catheter is inserted past the
foreign body and is gently dragged forward along the floor.

• For babies and uncooperative children general anaesthesia with cuffed

endotracheal tube can be used.
 COMPLICATION
S
Occurs if foreign body is left for a long time

1. nasal infection and sinusitis.

2. rhinolith formation.
3. inhalation into the tracheobronchial tree.
MAGGOTS ( NASAL MYIASIS)
atrophic rhinitis, syphilis, leprosy or infected
wounds

Flies attracted to foul smelling discharge

Lay about 200 eggs at a time

Hatch into larvae

LIFE CYCLE
 CLINICAL
1. First 3-4 days- Intense irritation, sneezing, lacrimation, headache and

FEATURES
thin blood-stained discharge. The eyelids and lips become puffy
2. On 3rd or 4th day- Maggots crawl out of the nose and patient is foul
smelling
3. They lead to destruction to nose, sinuses, soft tissue of face, palate
and the eyeball. Fistulae can form in the palate or around the nose.
4.Complication- meningitis and death
 TREATMEN
T
1. Removalby forceps
2. Maggots retreat into darker cavities when light falls on them therefore
instillation of chloroform water and oil kills them.
3. Nasal douche with warm saline is used to remove slough, crusts and
dead maggot
RHINOLITH
Foreign body, blood clot

Deposition of calcium and magnesium salts

Formation of rhinolith

grows into a large, irregular mass

which fills the nasal cavity

Necrosis of septum
and lateral wall
 CLINICAL
FEATURES
1. Unilateral nasal obstruction
2. foul-smelling discharge which can be bloodstained
3. Frank epistaxis and neuralgic pain can be caused due to ulceration of
the surrounding mucosa
4.Examination- grey brown or greenish-black mass with irregular
surface and stony hard feel.It is often brittle and sometimes surrounded
by granulations
Foreign bodies:
Air passages
 INTRODUCTION
• A foreign body can aspirate into air passage and lodge into
the larynx, trachea or bronchi depending on its size, shape
and nature.
• large foreign body can lodge in the supraglottic area
• Small ones can pass into larynx, trachea or bronchi.
• Foreign bodies with sharp
points(pins, needles, fish
bones) get stuck in the
larynx or tracheobronchial
tree.
 CLINICAL
FEATURES
• Initial period of
gagging, choking and
wheezing
• Symptomless period
• Later symptoms
 DIAGNOSI
• Detailed history- ingestion of foreign body, history of sudden onset of

S
coughing and wheezing
• Physical examination of neck and chest.
On auscultation diminished entry of air into the lungs
• Radiological examination
1. Soft tissue posteroanterior and lateral view of the neck
2.Plain X-ray chest in posteroanterior and lateral views
3.CT chest
4.Fluoroscopy/videofluoroscopy.
 MANAGEMEN
• Laryngeal foreign body- Heimlich manoeuvre. If it fails Cricothyrotomy or

T
emergency tracheostomy should be done.
• Tracheal or bronchial foreign body-
a. Conventional rigid bronchoscopy.
b.Rigid bronchoscopy with telescopic aid.
c. Bronchoscopy with C-arm fluoroscopy.
d. Use of Dormia basket or Fogarty’s balloon for rounded objects.
e. Flexible fibreoptic bronchoscopy in selected adult patients.
Conventional rigid bronchoscopy Flexible fibreoptic bronchoscopy
Dormia basket
Fogarty’s balloon
Foreign bodies:
Food passages
 AETIOLOG
• Age- children below the age of 5
•
•
Y
Loss of protective mechanisms
Carelessness
• Narrowed oesophageal lumen- oesophageal stricture or
carcinoma.
• Psychotics-attempted suicide
 SITES OF
Base of tongue-

LODGEMENT
Fish bones and
needles

Pyriform fossa- Tonsils-

Fish bone, chicken or a mutton needles and fish bone
bone, needle or a denture lodge in the crypts

Posterior pharyngeal wall:

staples,needles and
Oesophagus-
wires
coin, piece of meat, chicken bone,
denture, safety pin or a marble, disc
batteries
 CLINICAL
1. Symptoms

FEATURES
• History of choking or gagging.
• Discomfort or pain just above the clavicle on the right or left of trachea.
This increases while swallowing.
• Dysphagia-Obstruction to swallowing may be partial or total.
• Drooling of saliva is seen in cases of total obstruction. Sometimes saliva
may be aspirated causing pneumonitis.
• Respiratory distress.
• Substernal or epigastric pain
 2. Signs-
• Tenderness in the lower part of neck on the right or left of trachea.
• Indirect laryngoscope- Pooling of secretions in the pyriform fossa that do
not disappear on swallowing.
• protrusion of foreign body from the oesophageal opening in the postcricoid
region.
INVESTIGATIONS

PA and lateral view of neck

 MANAGEMEN
1.Endoscopic removal:Both rigid and flexible oesophagoscope
T
2.Cervical
oesophagotomy-
impacted foreign bodies
or those with sharp
hooks.
3.Transthoracic
oesophagotomy
4. A foreign body which has passed the pylorus of
stomach can pass through rest of gastrointestinal
tract therefore the stool should be examined daily
for 3–4 days. Patient should take a normal diet
and no purgative should be administrated to
hasten the passage.
 COMPLICATION
S
1. Respiratory obstruction
2. Perioesophageal cellulitis and abscess-occurs in the neck.
3. Perforation-mediastinitis, pericarditis or empyema. They may
perforate the aorta
4. Tracheo-oesophageal fistula
5. Ulceration and stricture. Overlooked foreign bodies may cause
slow ulceration and stricture formation.
 DISC BATTERIES
• contain sodium hydroxide, potassium hydroxide and mercury
• They leaks through them to cause oesophageal injury.
• Prolonged exposure at one place can lead to stricture, perforation,
tracheo-oesophageal fistula, mediastinitis and death.
• Management-
• promt removal from eosophagus
• If it is lodged in stomach, a radiographic follow up is conducted every
4–7 days and parents instructed to observe stools daily for
spontaneous passage.
THANK
YOU