Foreign Bodies in Ear Nose and Throat Edited

8/8/2019 Foreign Bodies in Ear Nose and Throat Edited

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Foreign BodiesForeign Bodies

In Ear Nose andIn Ear Nose andThroatThroatAdapted from sourceAdapted from source



FB AspirationFB Aspiration FBA is a common cause of mortality and

morbidity in children, especially in those youngerthan two years of age

Tracheobronchial foreign body aspiration is a

potentially life-threatening event During 2000, ingestion or aspiration of a foreign

body (FB) was responsible for 160 unintentionaldeaths and more than 17,000 emergencydepartment visits in children younger than 14years in the United States.

Before the 20th century, aspiration of a FB had avery high mortality rate. With the development of modern bronchoscopy techniques, mortality hasfallen dramatically



Death caused by suffocation following FBA is the fifth mostcommon cause of unintentional-injury mortality in theUnited States

Approximately 80 percent of these episodes occur inchildren younger than three years, with the peak incidencebetween one and two years of age

At this age, most children are able to stand, are apt toexplore their world via the oral route, and have the finemotor skills to put a small object into their mouths

Another presentation is the elder sibling putting various

objects in the younger brother¶s or sister¶s mouth



Commonly aspiratedforeign bodies inchildren include

peanuts (36 to 55percent of all FBs inWestern society),other nuts, seeds(particularly

watermelon seeds inMiddle Easterncountries), foodparticles, hardware,and pieces of toys



The majority of aspirated foreign bodies inchildren are located in the bronchi

Larynx: 3 percent

Trachea/carina: 13 percent Right lung: 60 percent (52 percent in the main

bronchus, 6 percent in the lower lobe bronchus,and <1 percent in the middle lobe bronchus)

Left lung: 23 percent (18 percent in the mainbronchus and 5 percent in the lower bronchus)

Bilateral: 2 percent



PresentationPresentation Children who present with severe respiratory distress,

cyanosis, and altered mental status have a truemedical emergency that demands prompt recognition

History of choking and coughing However, in the more common, less emergent

situation, the physical examination may revealgeneralized wheezing or localized findings such asfocal monophonic wheezing or decreased air entry.

The classic triad is wheeze, cough, and diminishedbreath sounds

They also can present delayed with fever and othersigns and symptoms of pneumonia Unresolving pneumonia and recurrence of pneumonia

also can be due to a FB in a distal bronchus



Plain radiographicevaluation of thechest may or may not

be helpful inestablishing thediagnosis of FBA,depending uponwhether the object is

radioopaque, andwhether and to whatdegree airwayobstruction is present



The most commonradiographic findingsin lower airway FBA

are hyperinflated lung,atelectasis,mediastinal shift, andpneumonia

-Obstructive

emphysema



ManagementManagement ABC

Life threatening FBA-rare to reach hospital, but if the child present with complete airwayobstruction-not speaking not coughing notbreathing and cyanosed dislodgement can beattempted

Back blows/chest compressions in infants

Heimlich Maneuver-older children

These intervention should be avoided in children

who have a partially compromised air waybecause this my convert a partial to a completeobstruction



ManagementManagement If imminent loss of air way is present rigid

bronchosopic extraction of the FB is the choice of treatment(but frequently not available at hand)

Intubation is the next best option and duringintubation if he FB seen in the larynx or abovethen it can be removed and airway cleared

Intubation may permit some ventilation until rigidbronchoscopy is possible

Vocal cords and cricoid ring are the narrowestpoints in the air way depending on the age

Therefore cricothyroid puncture also can beattempted in desperate situations (Thisprocedure will establish an airway whether it¶s a

FB or other causes of airway obstruction inma orit of cases



ManagementManagement Prevention of paediatric FBA is possible through

legislation, caregiver education, and continuedproduct safety vigilance.

Do not let children play with beads and smallhard objects and also age appropriate toys andfood should be given to them

Hard and/or round foods should not be offered tochildren younger than four years of age; theseinclude (but are not limited to), hot dogs,sausages, chunks of meat, grapes, raisins, applechunks, nuts, peanuts, popcorn, watermelonseeds, raw carrots, hard candy



Rigid Brochoscopy shouldbe performed ASP

Ventilating rigidbrochoscope, suctiontubes, various types of forceps and hopkins rodtelescopes hasrevolutionized endoscopicextraction of inhaled FBs

Flexible Bronchoscope maybe used specially in adults

Rarely removal via athoracotomy may beneeded





Foreign Body in NoseForeign Body in Nose

Common in children of 2-3yrs

Parents may notice child putting a FB or anaccidental finding

FB can be irritative to the mucosa and inturn giverise to a an inflammatory reaction

This will give rise to a unilateral offensive nasaldischarge (This a FB in the nose until provenotherwise)

There can be associated vestibulitis



ManagementManagement History and examination to confirm the presence

of a FB Examination of the anterior nares with light

reflected on the elevated tip of the nose

If nothing visible auroscope will give a betterview It is possible to remove without GA in many

children (Anteriorly placed visible FBs) First effort will be the best and often the only

attempt the child will allow. There is noemergency therefore do not rush have suction,instruments and assistant ready before doing this

Batteries and chemical containing FBs need to beremoved urgently

Sweets will dissolve and can clear spontaneously



Removal will be best accomplished with a hook orcurved instrument

It is passed point downwards above the FB,

which is brought to the floor of the nose andraked anteriorly

Forceps can also be used but caution in roundhard objects

In every case nasal cavity must be examinedafterwards as there can be second FB moreposteriorly





Counsel parentsCounsel parents

Child might cry

Bleeding-stop spontaneously

Failure of the procedure and residual Fbs

Second attempt under GA



Foreign Body in the EarForeign Body in the Ear Common in school children

Not uncommon in adults-usually its cotton buds

Non urgent situation unless live object

Animate object (live) make it inanimate (kill) bydrowning (use oil)

Most foreign bodies can be removed by syringing(with water)-do not use if ear drum is perforated

FB of vegetative origin may start to germinate

with contact with water and therefore theswelling of the FB may worsen the scenario



FB in the external ear canal is usually seen onotoscopy and removal may appear to be easy

But usually require the skills and facilities for thisbecause attempts of removal by untrained person

may lead to complications Suction and fine hooks can be used Super glue is in fashion these days but caution Operating microscope is required at times Once FB removed the ear should be examined to

check for any damage



FB in the OesophagusFB in the Oesophagus

Impaction is commonest at the cricopharyngeuslevel

Also where the oesophagus crossed by the left

main bronchus Strictures ? Malignant

Positive history, localise fairly accurately to thelevel of impaction, dysphagia and excessivesalivation are symptoms



Conservative methods(Specially if it is a foodbolus)

Buscopan

Benzodiazepines

Glucagon injections

Coca Cola

Examination and Radiography may be normal

Early esophagoscopy is required

Rigid Endoscopy is recommended for sharpobjects

Oesophageal perforation is a fatal complication





FB in the PharynxFB in the Pharynx

Sharp and irregular FBs may become impacted inthe tonsils, base of tongue, Vallecula andpyriform fossa

Small fish bones are the commonest and usuallylodged in the tonsil

Patient usually an adult will be able to localise theside and the site with reasonable accuracy

Removal under direct vision is the treatment



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Foreign Bodies in Ear Nose and Throat Edited