foreign bodies in otolaryngology

7/29/2019 Foreign Bodies in Otolaryngology

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F.Bs in

otolaryngology

Tarek Abdel Fattah (M.D)

otolaryngologistHearing & speech institute

Cairo- Egypt


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Introduction:

Foreign bodies removal is the most interesting

& rewarding( yet sometimes challenging) of all

ENT procedures

Occurs usually in children (tend to put anything

at any body orifice)

Dealt with urgently (but some are true

emergencies)

Need skill & practice (rising learning curve)


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Classification:

Ear

Nose

Pharynx

Larynx

Trachea

Esophagus


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Ear foreign bodies


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Types:

-Animate:

Ants, cockroaches, mosquitoes


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- inanimate:

1. vegetable: beans,seeds,penuts.

2. Non vegetable:Beads, plastics, toy pieces, cotton, rubber


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How to remove?

position:

child infant


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Instruments:

Depends on experience, type of F.B

(Some time you need to be creative)


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When we need G.A.?

struggling child, irritable adultimpacted or large F.B

Complications:- Trauma to Ext.A.canal.

- T.M perforation

- Ossicular disruption

- Facial palsy

PLZ dont try this at home


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Nasal F.Bs


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Types:

-Animate

- Inanimate:

vegetable

Non vegetable

When to suspect?

any child with unilateral, persistent, nasal

obstruction & offensive nasal discharge


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Imaging:


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How to remove:

position:

Instruments:


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Complications:

slip backwards to be inhaled



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Pharyngeal F.Bs


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Commonest F.Bs:

- fish bones

- chicken bones

large F.Bs cause dysphagia & drooling


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Complications:

finger sweeping of the F.B is extremely

dangerous



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Laryngeal F.Bs


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- uncommon:

needs very small or large or sharp F.B

- types:

Non obstructing:

Sudden coughing,chocking,stridor

Emergency removal under G.A

Ostructing:

Fatal (Caf coronary)

sudden loss of voice and breathingEmergency maneuvers


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PLZ we must all know how to do this athome


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Tracheal F.Bs


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Types:

When to suspect:

- history of chocking & coughingGiven by an adult or witnessed

by parents of a child

- Persistant chest symptoms.


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Investigations:

chest X-ray is most valuable


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Instruments:


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How to remove:


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Esophageal F.Bs

Distance is


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Normal

Constrictions

15 cm

25 cm

40 cm

Distance is

measured from

central incisor

Oesophageal inlet:

cricothyroid muscle

Oro &

hypo-

pharynx

At crossing of aortic arch

& left main bronchus

At its end when it enters

through the diaphragm


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Conclusion:

- Foreign bodies removal is the most

interesting & rewarding( yet sometimeschallenging) of all ENT procedures

- should be removed by an experienced ENT

surgeon- Dont try to be a hero. Dont get driven by

the temptation of removing the F.b in the

awake struggling child- Always check for a second F.B


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The EndThank You

foreign bodies in otolaryngology

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