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

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

12. Foreign body in the nose

13. 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.

14. 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

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

16. 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

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

19. • 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

20. • 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

21. 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

22. 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

23. 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

24. Laryngeal foreign bodies
• Laryngeal foreign bodies usually cause complete or partial airway
obstruction.

25. • 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

26. • 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
• The larynx, trachea, or bronchus

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

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

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

31. 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

32. • 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.

33. investigation
• Xray
• Fluoroscopy

34. Management
• Bronchoscopy(under general anesthesia)

35. 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.