foreign bodies in ear nose and throat edited
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Foreign BodiesForeign Bodies
In Ear Nose andIn Ear Nose andThroatThroatAdapted from sourceAdapted from source
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FB AspirationFB Aspiration FBA is a common cause of mortality and
morbidity in children, especially in those youngerthan two years of age
Tracheobronchial foreign body aspiration is a
potentially life-threatening event During 2000, ingestion or aspiration of a foreign
body (FB) was responsible for 160 unintentionaldeaths and more than 17,000 emergencydepartment visits in children younger than 14years in the United States.
Before the 20th century, aspiration of a FB had avery high mortality rate. With the development of modern bronchoscopy techniques, mortality hasfallen dramatically
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Death caused by suffocation following FBA is the fifth mostcommon cause of unintentional-injury mortality in theUnited States
Approximately 80 percent of these episodes occur inchildren younger than three years, with the peak incidencebetween one and two years of age
At this age, most children are able to stand, are apt toexplore their world via the oral route, and have the finemotor skills to put a small object into their mouths
Another presentation is the elder sibling putting various
objects in the younger brother¶s or sister¶s mouth
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Commonly aspiratedforeign bodies inchildren include
peanuts (36 to 55percent of all FBs inWestern society),other nuts, seeds(particularly
watermelon seeds inMiddle Easterncountries), foodparticles, hardware,and pieces of toys
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The majority of aspirated foreign bodies inchildren are located in the bronchi
Larynx: 3 percent
Trachea/carina: 13 percent Right lung: 60 percent (52 percent in the main
bronchus, 6 percent in the lower lobe bronchus,and <1 percent in the middle lobe bronchus)
Left lung: 23 percent (18 percent in the mainbronchus and 5 percent in the lower bronchus)
Bilateral: 2 percent
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PresentationPresentation Children who present with severe respiratory distress,
cyanosis, and altered mental status have a truemedical emergency that demands prompt recognition
History of choking and coughing However, in the more common, less emergent
situation, the physical examination may revealgeneralized wheezing or localized findings such asfocal monophonic wheezing or decreased air entry.
The classic triad is wheeze, cough, and diminishedbreath sounds
They also can present delayed with fever and othersigns and symptoms of pneumonia Unresolving pneumonia and recurrence of pneumonia
also can be due to a FB in a distal bronchus
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Plain radiographicevaluation of thechest may or may not
be helpful inestablishing thediagnosis of FBA,depending uponwhether the object is
radioopaque, andwhether and to whatdegree airwayobstruction is present
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The most commonradiographic findingsin lower airway FBA
are hyperinflated lung,atelectasis,mediastinal shift, andpneumonia
-Obstructive
emphysema
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ManagementManagement ABC
Life threatening FBA-rare to reach hospital, but if the child present with complete airwayobstruction-not speaking not coughing notbreathing and cyanosed dislodgement can beattempted
Back blows/chest compressions in infants
Heimlich Maneuver-older children
These intervention should be avoided in children
who have a partially compromised air waybecause this my convert a partial to a completeobstruction
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ManagementManagement If imminent loss of air way is present rigid
bronchosopic extraction of the FB is the choice of treatment(but frequently not available at hand)
Intubation is the next best option and duringintubation if he FB seen in the larynx or abovethen it can be removed and airway cleared
Intubation may permit some ventilation until rigidbronchoscopy is possible
Vocal cords and cricoid ring are the narrowestpoints in the air way depending on the age
Therefore cricothyroid puncture also can beattempted in desperate situations (Thisprocedure will establish an airway whether it¶s a
FB or other causes of airway obstruction inma orit of cases
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ManagementManagement Prevention of paediatric FBA is possible through
legislation, caregiver education, and continuedproduct safety vigilance.
Do not let children play with beads and smallhard objects and also age appropriate toys andfood should be given to them
Hard and/or round foods should not be offered tochildren younger than four years of age; theseinclude (but are not limited to), hot dogs,sausages, chunks of meat, grapes, raisins, applechunks, nuts, peanuts, popcorn, watermelonseeds, raw carrots, hard candy
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Rigid Brochoscopy shouldbe performed ASP
Ventilating rigidbrochoscope, suctiontubes, various types of forceps and hopkins rodtelescopes hasrevolutionized endoscopicextraction of inhaled FBs
Flexible Bronchoscope maybe used specially in adults
Rarely removal via athoracotomy may beneeded
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Foreign Body in NoseForeign Body in Nose
Common in children of 2-3yrs
Parents may notice child putting a FB or anaccidental finding
FB can be irritative to the mucosa and inturn giverise to a an inflammatory reaction
This will give rise to a unilateral offensive nasaldischarge (This a FB in the nose until provenotherwise)
There can be associated vestibulitis
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ManagementManagement History and examination to confirm the presence
of a FB Examination of the anterior nares with light
reflected on the elevated tip of the nose
If nothing visible auroscope will give a betterview It is possible to remove without GA in many
children (Anteriorly placed visible FBs) First effort will be the best and often the only
attempt the child will allow. There is noemergency therefore do not rush have suction,instruments and assistant ready before doing this
Batteries and chemical containing FBs need to beremoved urgently
Sweets will dissolve and can clear spontaneously
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Removal will be best accomplished with a hook orcurved instrument
It is passed point downwards above the FB,
which is brought to the floor of the nose andraked anteriorly
Forceps can also be used but caution in roundhard objects
In every case nasal cavity must be examinedafterwards as there can be second FB moreposteriorly
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Counsel parentsCounsel parents
Child might cry
Bleeding-stop spontaneously
Failure of the procedure and residual Fbs
Second attempt under GA
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Foreign Body in the EarForeign Body in the Ear Common in school children
Not uncommon in adults-usually its cotton buds
Non urgent situation unless live object
Animate object (live) make it inanimate (kill) bydrowning (use oil)
Most foreign bodies can be removed by syringing(with water)-do not use if ear drum is perforated
FB of vegetative origin may start to germinate
with contact with water and therefore theswelling of the FB may worsen the scenario
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FB in the external ear canal is usually seen onotoscopy and removal may appear to be easy
But usually require the skills and facilities for thisbecause attempts of removal by untrained person
may lead to complications Suction and fine hooks can be used Super glue is in fashion these days but caution Operating microscope is required at times Once FB removed the ear should be examined to
check for any damage
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FB in the OesophagusFB in the Oesophagus
Impaction is commonest at the cricopharyngeuslevel
Also where the oesophagus crossed by the left
main bronchus Strictures ? Malignant
Positive history, localise fairly accurately to thelevel of impaction, dysphagia and excessivesalivation are symptoms
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Conservative methods(Specially if it is a foodbolus)
Buscopan
Benzodiazepines
Glucagon injections
Coca Cola
Examination and Radiography may be normal
Early esophagoscopy is required
Rigid Endoscopy is recommended for sharpobjects
Oesophageal perforation is a fatal complication
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FB in the PharynxFB in the Pharynx
Sharp and irregular FBs may become impacted inthe tonsils, base of tongue, Vallecula andpyriform fossa
Small fish bones are the commonest and usuallylodged in the tonsil
Patient usually an adult will be able to localise theside and the site with reasonable accuracy
Removal under direct vision is the treatment
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