Foreign body in ENT

Foreign body in ENT and its management

1. Foreign Body in ENT DR O.A OPADOTUN Babcock University Teaching Hospital

2. Definition An object is considered a "foreign body" if the object is in a location in the body where it does not belong. Most airway foreign body aspirations occur in children younger than 15 years. Children aged 1-3 years are the most susceptible

3. Common foreign bodies Pebbles Slate pencils Beads marbles peas Beans nuts button batteries paper wads Buttons

4. Risk factors Age: commoner in pediatrics, esp between 1-5years. Adults with mental retardation Time of the year, commoner during holiday periods when children are free to play around

5. Principle of foreign body removal Adequate patient exposure Patient must be well relaxed Adequate lighting Adequate skill

6. classification ANIMATE: 1. Maggot 2. Worms 3. Cockroach 4. Beetles 5. Ants 6. Flies INANIMATE: 1. Vegetable FB :paes ,beans 2. Mineral FB : metal , plastic toys 3. Post surgical : swabs , packs, cotton buds 4. Sequestra : syphilis , neoplasms 5. Eraser, crayon

7. Ear foreign body Common in Paediatric age group Insects are seen in adults Rarely urgent-Can Wait Mostly in ear canal

8. Techniques of Removal Forceps Removal Ear Syringing Suction method Microscopic removal Postaural Approach Ear drops-post removal

9. Foreign body in the nose

10. Battery result in severe destruction of the nasal septum . These are composed of various types of heavy metals: mercury, zinc, silver, nickel, cadmium, and lithium. Liberation of these substances cause various types of lesions depending on the localisation , it causes intense local tissue reaction and liquefaction necrosis. As a result they can cause septal perforations , synechiae , constriction, and stenosis of the nasal cavity.

11. Consequences Inert Foreign body Infection and inflammation of mucous membrane Granulation tissue formation and ulceration of mucosa Necrosis of bone or cartilage Vegetable foreign body Absorb water and swell evoke brisk inflammatory response

12. symptoms Unilateral fetid discharge: mucopurulent or blood stained u/l nasal obstruction Pain Nasal bleed Excoriation of nasal vestibular skin

13. Local examination Main diagnostic tool Object mostly found beneath inferior turbinate or anterior to middle turbinate Erythema ,edema Bleeding ,fetid nasal discharge Visualize T.M for acute otitis media Assess for sinusitis

14. Investigations Nasal endoscopy X-ray may reveal radiopaque FB NCCT nose and PNS

15. POSITIVE PRESSURE TECHNIQUE: Tell the kid that parent is going to give them a kiss Instruct the parent to form a good seal on the mouth and then blow into mouth while occluding unaffected nostril It has a very low risk of barotrauma (< 60mm hg ) , similar to a sneeze

16. Child is restrained in upright position Add few drops of nasal decongestant Proper suctioning to visualise FB Curved hook is passed beyond FB And gradually drawn forward and removed completely

17. Using Fogarthy catheter Ensure that balloon is intact Catheter is placed beyond the foreign body Balloon is then inflated Catheter is withdrawn through the anterior nares pulling the foreign body

18. Indication for GA Uncooperative and very apprehensive patients If troublesome bleeding is anticipated If the FB is posteriorly placed with a risk of pushing it back in to nasopharynx If a foreign body is strongly suspected but cannot be seen in anterior rhinoscopy

19. Removal under GA Patient is anaesthetised with cuffed ET tube Pharyngeal pack placed If FB is placed posteriorly , patient positioned in rose position and mouth gag applied. Palate is generally retracted with a catheter which is placed through unaffected nasal cavity FB is pushed from anterior nares in to the nasopharynx and pick up with foreps

20. Laryngeal foreign bodies Laryngeal foreign bodies usually cause complete or partial airway obstruction.

21. Young children are susceptible because: They lack molars for proper grinding of food . They tend to be running or playing at the time of aspiration. They tend to put objects in their mouth more frequently. They lack coordination of swallowing and glottic closure

22. Food items are aspirated most commonly; Nuts or small food particles are the most frequently aspirated food After foreign body aspiration occurs, the foreign body can settle into 3 anatomic sites T he larynx, trachea, or bronchus

23. Symptoms Stridor(abnormal , high-pitched, musical breathing sound) Cough Hoarseness Dyspnoea Odynophagia or dysphagia Aphonia

24. management Heimlich manoeuvre X-ray soft tissue neck Laryngoscopy Tracheotomy

25. Tracheobrochoncial foreign body The main symptoms are episodes of coughing, intermittent or continuous dyspnea with cyanosis, pain Intermittent hoarseness

26. Site This depends on the size Shape of the foreign body. The most common site is the right main bronchus because of its straighter angle of origin from the trachea

27. If the foreign body is retained for a longer period the following can occur depending on the type of foreign body and duration: 1. accumulation of secretions; 2. tracheitis or bronchitis with edema, 3. swelling, and granulations; 4. bleeding and bloodstained secretions ; 5 . partial obstruction of the lower airway or emphysema ; 6 . atelectasis or overinflation of the poststenotic part of the lung.

28. investigation Xray Fluoroscopy

29. Management Bronchoscopy(under general anesthesia)

30. References 1. ENT Foreign body by Dr Chhagan Dangi 2. Airway Foreign Body By Mohd Nasiruddin Mansor 3.   DiMuzio J Jr, Deschler DG. Emergency department management of foreign bodies of the external ear canal in children.  Otol Neurotol . 2002;23:473–5 .... 4. Steven W. Heim, MD, MSPH, and Karen L. Maughan, MD Foreign Bodies in the Ear, Nose, and Throat Am Fam Physician.  2007 Oct 15;76(8):1185-1189.