Foreign Bodies in Ent Yr 6

FOREIGN BODIES
IN ENT
DR M. SITIMA
EAR
 Common in paediatric age group 2-4yr
 Rare in adults (cockroaches)
 M:F=1:1
 Types
 animate- insects, lice
 inanimate- vegetable(seeds) (they swell up when
syringed)
 Non vegetable ( metal, plastic, stones, pebbles)
 Can present in hours , days or months.
SITE
 Canal, middle ear

 Rt ear> LT ear
 bilateral is rare
 Method of removal depends on the nature, size,
consistency site
 Needs good lighting
 Syringing
 should be small
 not vegetable
 not impacted ie loose in the meatus
 A Hook for
 Hygroscopic objects
 FB not occluding whole meatus
 Bypass FB, turn hook, pull out.
 Forceps- grasps
 good for vegetable material, pebbles
 Do not use for round substances
 Surgery - FB lodged in middle ear and beyond
 If possible no anaesthesia unless
 Uncooperative patient,
 FB is impacted,
 FB is in middle ear,
 FB difficult to visualise
COMPLICATIONS
 Tympanic membrane perforation because of
unskilled attempt at removal
 Conductive hearing loss (FB in canal, ossicular
chain disruption)
 Trauma to canal
 Otitis externa (FB reaction)
 Vertigo: avulsion of stapes (leakage of perilymph)
NOSE
 Commoner in children, mentally retarded (older
children , adults less)
 Penetrating injuries
 Post op FB (swabs)
Modes of entry
 Anterior nares
 Post nares: vomiting
 Penetrating wounds
 Palatal perforation eg cleft palate
Sites
 Rt>Lt side
 Any part of nasal cavity ant, mid, deep
 Types
1. Animate- roundworms, maggots
2. Inanimate- vegetable material or non vegetable
material ( metals, toys, pebbles)
Signs and Symptoms
 Usually unilateral (animate usually bilateral)
 Vegetable FB: beans- unilateral fetid mucopurulent
discharge, sometimes blood stained.
 Unilateral nasal discharge and nasal obstruction
 Pain, epistaxis and sneezing
 Animate( headache, foul smelling discharge, feels
things moving in the nose, nasal obstruction)
O/E
 Congested red mucosa
 Mucopus
 Ulceration
 Granulation
 May see FB itself
HOW TO REMOVE
 Animate: 25% chloroform or parafin drops
 Tell patient to blow nose and remove with forceps
 Inanimate: Hook (round objects) pass hook on the floor
of the nose , past FB turn it and pull
 Usually under LA. GA if;
 uncooperative patient, apprehensive ,
 FB firmly embedded in tissues
 Posterior FB (difficult) can slip into hypopharynx & inhaled
 If FB cannot be seen.
 RHINOLITH
 stone formed in situ in nose, rare
 Needs GA to break up and remove piecemeal
OESOPHAGUS
Areas of constriction:
1. Postcricoid area (cricopharyngeus) 15cm from
incisors.
2. Aortic arch 25cm
3. Lt main bronchus 27cm
4. Diaphragmatic hiatus 40cm
 Most common site is the postcricoid region.
Pathological constrictions ;
1. Peptic esophagitis
2. Corrosive stenosis
3. Congenital stenosis
Clinical presentation
 Hx of ingestion of FB
 Choke and cough in a child
 Excessive salivation
 Dysphagia
 haematemesis may occur in some cases
Manangement
 Xray
 CXR
 Barium swallow
 CT scan
 Endoscopy (diagnostic and therapeutic)
 Oesophagoscopy (rigid) and removal
 If it is deeper observe and see whether it will pass
COMPLICATIONS
 Ulcerations
 Stricture formation
 Tracheoesophageal fistula
 Erosion through wall of esophagus to major blood
vessel
 Mediastinal abscess
 Perforation of esophagus (air in mediastinum)
Types of FB’s
 Fish bones, coins , disc batteries, meat, dentures.
LARYNX, TRACHEA,
BRONCHUS
 Commoner in 2-3yrs because they like putting things
in the mouth
 rare in adults
 Forced inspiration during chewing, eating (eg crying
with an FB)
TYPES
 Vegetable material (mostly), groungnut, maize, beans,
bone, popcorn, fruit seeds.

 Non-vegetable: metals, pins, beads, stones, charcoal.
HISTORY
 Sudden choking followed by paroxysmal (on and
off) cough, wheezing
 In hospital: unexplained persistent fever.
 ARDS
 Triad- choke, cough, wheeze, (hx of FB)
 Can present in days , hours or weeks.
 84% in laryngotracheal tree present early (hrs-
days)
O/E
 Respiratory distress
 Cyanosis
 Change of voice or cry
 Stridor
 Auscultation
 Audible click as FB moves up and down
 Unilateral expiratory wheeze.
 Decreased air entry bilateral (trachea) or unilateral
(bronchi)
 Pneumonic changes: creps and crackles.
Sites
SITE PERCENTAGE
Rt main bronchus 51.6%
Trachea 35.1%
Lt main bronchus 12.4%
Larynx 0.9%
Bilateral 0%
 Rt main bronchus is wider and more in line with
the trachea.
 Interbronchial septa more to the left (carina)
 FB may change position eg coughed up from Rt
bronchus to the left.
MANANGEMENT
 CXR(AP/LAT)
 X-ray- may be normal when early or FB not radio
opaque
 Lung collapse
 Mediastinal shift
 FB may be seen
 Obstructive emphysema: ball-valve mechanism
 Pneumonic changes.
 CT Scan
TREATMENT
 Bronchoscopy (rigid)
 If in the larynx (remove via laryngoscopy)
 Cough out FB: conservative management before
treatment.
 FB is an emergency
COMPLICATIONS
 Laryngeal edema
 URTI
 Death
 Pneumonia, lung abscess
 Bronchiocutaneous fistula
 If FB is impacted (Thoracotomy).

Foreign Bodies in Ent Yr 6

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FOREIGN BODIES

 Canal, middle ear

 Erosion through wall of esophagus to major blood

 Perforation of esophagus (air in mediastinum)

 Forced inspiration during chewing, eating (eg crying

bone, popcorn, fruit seeds.

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