Foreign bodies in otolaryngology

From Otolaryngology Online

Foreign bodies in otolaryngology:

Children are known to insert a myriad of foreign bodies into their body cavities. Ears, nose and throat are easily accessible to children. Mentally deranged adult individuals are also commonly known to insert foreign bodies into their ears nose and throat.

Children insert foreign bodies in to their ears /nose / throat due to ignorance and curiosity. Mentally deranged individuals insert foreign bodies into their body cavities. Accidental insertion of foreign bodies are common in adults

Type of foreign bodies inserted can be classified into:

Organic :

This again may be subdivided into animate and inanimate foreign bodies. Inanimate foreign bodies include seeds. Animate foreign bodies include insects. Maggots are known to commonly involve nasal cavities with foul smelling discharge. Insects and worms can accidentally enter the ear. When seeds are inserted into ear or nose they have a tendency to swell on exposure to moisture. Aural syringing should not be resorted to as it will cause rapid swelling of the seed within the ear canal, making their removal difficult. Organic foreign bodies in nose if present for a prolonged duration may cause foul smelling unilateral nasal discharge. Animate foreign bodies like insects, maggots should be stifled with liquid paraffin before removal.

Inorganic foreign bodies: These include commonly available house hold items. Impacted in organic foreign bodies in the ear should always be removed under anesthesia. Unimpacted foreign bodies inside the external ear canal can be removed by aural syringing. Foreign bodies involving the throat get impacted just above the level of cricopharynx. It could also get impacted in any of the narrowed portions of oesophagus. Oesophagoscopy should be done to remove these foreign bodies.

Foreign bodies involving the airway are highly risky to remove. The air way should be shared between the anesthetist and the surgeon performing Bronchoscopy. This adds further to the risk. Foreign bodies involving the air way gets commonly stuck in the right main bronchus, since this bronchus is a direct continuation of trachea. Rigid Bronchoscopy should be performed under jet ventilation anesthesia to remove these foreign bodies.

Role of X-rays in the management of foreign bodies:

X-rays are useful in identifying the site of foreign bodies if they get lodged in the airway or food passages. Radio opaque foreign bodies like coins, bone pieces can be clearly visualized on an x-ray. Fish bones are commonly radiolucent and less readily visualized in an x-ray. X-ray chest will reveal either direct or indirect evidence of foreign body in the air passage. It also reveals the presence of collapse, emphysema or abscess of the involved lobe of the lung. These events are more common in long standing foreign bodies.