Foreign Bodies In ENT - Types, Clinical features, Investigations and Management.pdf

Foreign bodies in the ear, nose, and throat (ENT) are a common occurrence, particularly in children but also in adults. These objects can range from small items like beads or food particles to larger objects such as toys or parts of instruments. In the ear, foreign bodies often cause pain, hearing loss, or discharge if left untreated. In the nose, they can lead to nasal obstruction, foul-smelling discharge, or even respiratory distress. In the throat, foreign bodies may cause difficulty swallowing, choking, or persistent coughing. Prompt medical evaluation and removal are crucial to prevent complications and ensure optimal outcomes in managing ENT foreign bodies.

1. -Dr. S. Thillaikkarasi
Batch - CRMI 64
GCMCH
FOREIGN
BODIES IN ENT

2. “
An object is considered a “foreign body” if
the object is in a location in the body where
it does not belong.
2

3. Common foreign bodies
Pebbles
Slate pencils
Beads
Peas
Beans
Nuts
Button batteries
Buttons
3

4. Types of
foreign
bodies
NON LIVING/ INANIMATE
●Vegetables (peas, beans,
grains)
●Mineral fb (metal, plastic
toys)
●Post surgical (swabs,
packs)
●Eraser, crayons, chalks,
piece of paper
●Matchsticks, ear buds used
for scratching the ear

LIVING/ ANIMATE
●Maggot
●Worms
●Cockroach
●Beetles
●Ants
●Flies
●Mosquitoes
4

5. Risk
factors
▹Age: Commoner in pediatric age group, especially
between 1 and 5 years
▹Psychotics
▹Carelessness
▹Poor hygiene
▹Loss of protective mechanims
▹Common during holidays, when children play
around
5

6. 6
Foreign
bodies
Ear
Nose
Throat
Air passage
Food passage

7. Foreign body ear
1
7

8. Mostly, foreign bodies get lodged in the narrowing at the
bony cartilaginous junction
8

9. Clinical
features Most common
▹Asymptomatic

▹Fullness or pressure

▹Decrease in hearing

▹Irritation, pain
Others
▹Redness
▹Swelling
▹Discharge
▹In extreme cases,
when tympanic
membrane is injured
it can cause
dizziness, nausea,
unsteady gait etc,.
9

10. Investigations
▹Otoscope
visualization
▹X-ray may reveal
opaque FB
10

11. Management
▹Forceps removal
▹Ear syringing
▹Suction method
▹Microscopic removal with special instruments
▹Postaural approach
11

12. Forceps
removal
Soft and irregular foreign
bodies like a piece of
paper, swab or a piece of
sponge can be removed
with fine crocodile
forceps.
12

13. Ear
syringing
Most of seed grains and
smooth objects can be
removed with syringing as
smooth objects tend to
move inward and can
injure TM.
13

14. Position
▹Patient is seated with ear to be
syringed towards the examiner
▹A towel is placed round his neck
and kidney tray is placed over the
shoulder and held snugly by the
patient
▹Patient's head is tilted over the
tray to collect the return fluid.
Technique of syringing the ear
14

15. ▹Pinna is pulled upwards & backwards and a stream of water from the
ear syringe is directed along the posterio-superior wall of the meatus
▹If the FB is impacted tightly, it is necessary to create a space
between it and jet of water to pass, otherwise syringing will be
ineffective or may push the FB deeper
▹At the end of the procedure, ear canal and TM must be inspected

NOTE
Hard impacted mass may require prior softening with wax solvents
or cerumenolytics.
15

16. ▹Otitis externa
▹Vertigo
▹Perforation of the TM
▹Middle ear damage, if the TM
is perforated
▹Symptoms- sudden pain,
ringing in the ears, loss of the
ability to hear, nausea, and
dizziness
Complications
16
▹Perforation of TM (can push
wax into middle ear leading to
infection)
▹Vegetative FB (swells up
during syringing)
▹Battery as FB (water during
syringing makes battery content
to leak and cause liquefactive
necrosis of EAC).
Contraindications

17. Suction method
17
Microscopic removal

18. Living FB
SYMPTOMS
▹Foul smelling
ear discharge or
blood stained
discharge
▹Pain
▹Swelling
▹Intense
irritation
TREATMENT
▹Instill
chloroform
water or oil or
spirit to kill the
insect
▹Once killed, the
insect can be
removed by any
of the previous
methods
18

19. Foreign body nose
19
2

20. FBs commonly lodge below the inferior turbinate and
anterior to the middle turbinate
20

21. Clinical
features ▹History of FB
▹Unilateral foul smelling nasal discharge
(sometimes bloodstained)

THE DICTUM
“If a child presents with unilateral
foul-smelling nasal discharge, foreign
body must be excluded.”
21

22. Rhinolith
▹Stone formation in nasal
cavity
▹Forms around the nucleus
of small exogenous FB,
blood clot or secretions by
slow deposition of calcium
and magnesium salts
▹More common in adults
▹Grayish brown/ greenish
black stony, irregular, brittle
mass
22

23. Nasal
myiasis ▹Larval forms of flies- Chrysomyia
▹Attracted to foul smelling
discharge (atrophic rhinitis,
syphilis, leprosy, infected wounds)
▹Pt presents with sneezing,
lacrimation,intense irritation,
headache, epistaxis, foul smell
▹Can cause destruction of nose,
sinuses, soft tissue of face, palate
and eyeball
▹Death may occur from meningitis
23

24. ▹History
▹Clinical features and
local examination
▹Nasal endoscopy
▹X-ray nose to confirm
and localize the FB, if
it's radio opaque
▹CT nose
Investigations
24

25. Management
Inanimate FBs
▹Paper or cotton pieces can be removed with a pair of
forceps
▹Rounded FBs can be removed by passing a blunt hook,
like eustachian catheter, past the FB and gently
dragging it forward along the floor
▹In babies and uncooperative pts;
GA is given and placed in Rose's position. A pack is
inserted into the nasopharynx and the FB is retrieved
using forceps or a hook
25

26. 26
▹FBs lodged far behind are pushed into nasopharynx before
removal
▹Rhinolith are removed under GA through the anterior nares.
Large ones are broken into pieces before removal
▹Some particularly hard, irregular ones require lateral rhinotomy
Animate FBs
▹Visible maggots should be picked up with forceps
▹Installation of chloroform water or oil kills them
▹Nasal douche with warm saline is used to remove slough, crusts
and dead maggots
▹The pt should be isolated with mosquito net to avoid contact with
flies

27. Foreign bodies of
air passages
27
3

28. Location of impacted foreign bodies: Larynx- 10%;
Trachea- 15%; R.bronchus- 40%; L.bronchus- 35%.
28

29. Etiology
▹Most often, children below 4 yrs
are affected
▹Vegetable FBs- Peanuts, almonds,
peas, beans, watermelon seeds etc.
▹Nonvegeteable FBs- plastic toys,
whistles, safety pins, ball bearings,
beads etc.
▹In adults, aspiration is common
during coma, deep sleep or alcohol
intoxication
29

30. 30
Stages of foreign body aspiration
INITIAL PERIOD OF
CHOKING, GAGGING
AND WHEEZING
SYMPTOMLESS
INTERVAL
●Lasts for short time
●FB maybe coughed
out or pushed down
in the
tracheobronchial
tree
●Lasts for a few hours
to weeks
●The respiratory
mucosa adapts
LATER SYMPTOMS
●Caused by airway
obstruction,
inflammation or
trauma by the
foreign body
●Depends on the site
of lodgement

31. 31

32. Classical
triad
Sudden onset
of coughing
Wheezing
Diminished
entry of air
into lungs on
auscultation
32

33. Investigations
X-ray ▹Soft tissue
PA and
lateral view
of neck in
extended
position
▹Larynx,
trachea
▹Flat FB in
trachea lies
flat on lat
view
▹Plain X-ray chest
PA and lateral
view
▹Shows lobar/
segmental
atelectasis;
unilateral
hyperinflation;
pneumomediastin
um or
pneumothorax;
pneumonitis
OTHERS
▹X-ray chest at
end if
inspiration
and
expiration
▹Fluoroscopy/
videofluorosc
opy
▹CT chest
33

34. 34
Coin as FB in larynx

35. Management LARYNGEAL FOREIGN BODY

35

36. Methods to remove
▹Conventional rigid bronchoscopy
▹Rigid bronchoscopy with telescopic aid
▹Bronchoscopy with C-arm aid
▹Use of Dormis basket or Fogarty’s balloon
▹Tracheostomy and then bronchoscopy
▹Flexible fibreoptic bronchoscopy
TRACHEAL AND BRONCHIAL FOREIGN BODY
36

37. Foreign bodies of
food passages
37
4

38. 38
Most common site- cricopharyngeal sphincter
Other sites include tonsil, vallecula, post pharyngeal wall, pyriform
fossa, esophagus

39. Clinical
features
▹History of choking or
gagging
▹Discomfort or pain
▹Dysphagia
▹Drooling of saliva
▹Respiratory distress
▹Substernal or epigstric
pain
▹Asymptomatic in
partial obstruction
▹Tenderness in lower
neck on the right or
left of trachea
▹Pooling of secretions
in pyriform fossa on
indirect laryngoscopy
▹Protruding in the
postcricoid region
39

40. Investigations
▹X-ray PA and lateral view of
neck, chest and abdomen
▹Flat FB in esophagus lies
flat on PA view and edge on
lateral view
▹Radiolucent FBs may
resemble an air bubble in
lateral view of neck
▹Disc batteries cast a double
shadow or stalked coin
appearance
40
Fishbone in esophagus

41. 41
Coin as FB in esophagus

42. Management
▹Oesophagoscopy- m/c used
-Under GA
-Rigid or flexible scope is used
▹Cervical oesophagotomy
-For impacted FBs above thoracic inlet
▹Transthoracic oesophagotomy
-For impacted FBs of thoracic esophagus
▹Stool examination daily for 3-4 days if FB has
passed the pylorus of stomach


42

43. 43

44. Operative interference when,
▹Pain and tenderness in abdomen
▹No progress on periodic x-rays taken in few days interval
▹Objects that are sharp or likely to perforate or get obstructed
▹>5cm in 2 yr old, disc battery > 1.5cm in 6 yr old
▹Pyloric stenosis
Complications
▹Respiratory obstruction
▹Perioesophageal cellulitis or abscess
▹Perforation
▹TE fistula
▹Ulceration and stricture

44

45. Disc
batteries
▹Contains sodium hydroxide,
potassium hydroxide and
mercury
▹Can cause esophageal injury,
stricture, perforation, TE
fistula, mediastinitis and
death
▹Damage to mucosa- 1 hr,
muscle coat- 2 to 4 hrs,
perforation- 8 to 12 hrs
▹If lodged in stomach, x-ray
follow up every 4-7 days and
daily stool monitoring done
45
Double shadow
appearance of disc
battery

46. 46
COIN AS
FOREIGN
BODY

47. 47
Diseases of Ear, Nose and Throat
& Head and Neck Surgery- 7th edition

-PL Dhingra
Reference

48. ?ank you!
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