This document discusses foreign bodies in the ear, nose, and throat. It notes that foreign body aspirations most commonly occur in children under 15, especially between ages 1-3. Common foreign bodies include small objects like beads, nuts, and buttons. Symptoms depend on the location of the foreign body but may include obstruction, pain, discharge, or difficulty swallowing. Examination and sometimes imaging can identify the object's location. Removal techniques vary by location but often involve irrigation, suction, or endoscopy under anesthesia if needed. Complications may occur if objects are left in place for a long time.

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.