Postgraduate Medicine
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Foreign Bodies in the Ear, Nose, and Throat Stephen G. Harner To cite this article: Stephen G. Harner (1975) Foreign Bodies in the Ear, Nose, and Throat, Postgraduate Medicine, 57:6, 82-83, DOI: 10.1080/00325481.1975.11714047 To link to this article: https://doi.org/10.1080/00325481.1975.11714047
Published online: 07 Jul 2016.
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• What are the three basic methods of removing a foreign body from the ear? • What is the classic finding that indicates a foreign body in the nose? • ln what part of the throat do bones most often become lodged?
STEPHEN G. HARNER, MD Mayo Clinic and Mayo Foundation Rochester, Minnesota
Foreign Bodies in the Ear, Nose, and Throat Foreign Bodies in the Ear
Foreign bodies inserted into the ear can be any size or shape and of any material. The size is limited by the size of the externat ear canal, and the material nearly always is wedged into the canal or nearly fills it. The size and shape of the foreign body should be determined, because this information is needed in deciding the easiest method of removal. The methods of removal fall basically into three categories. The first and easiest is to wash the material out. This is especially good for removal of earwax. The second method is suctian; often the foreign body can be removed with the suction tip alone. The third method is to use one of the many types of forceps. Many foreign bodies in the ear can be removed without the use of anesthesia, but if the patient is not cooperative or if the manipulations are painful, sorne type of anesthesia is needed. In the adolescent or adult, injection of lidocaine in the externat ear canal may be suffident. However, since most patients with foreign bodies in their ears are less than 6 years old, such injections are not possible. The child should not be sedated, because sedation does not provide anesthesia, and although the child
82
may be relaxed, as soon as his ear is touched he will move, which could cause much damage from the instruments. Therefore, general anesthesia is best. Removal of a foreign body from the ear is not an emergency and can be undertaken later in the same day or the next day. The patient who is given a general anesthetic usually does not require intubation and thus can be treated as an outpatient. Foreign Bodies in the Nose
The usual history is one of a child voluntarily inserting something into the nose. Any child who has unilateral purulent drainage from the nose must be suspected of having either a choanal atresia or a for~ign body in the nose. The latter is the more common. Examination of the nasal cavity usually reveals the nature of the foreign body. If there is much drainage and there is doubt about whether or not a foreign body is present, sinus roentgenograms may be of sorne benefit if the foreign body is radiopaque. As with foreign bodies in the ear, succion is often effective, probably more so in the nose than in the ear. Forceps removal is the most effective method. If succion or forceps are to be
POST8RADUATE MEDICINE • May 1975 • Vol. 57 • No. 6
used, usually no anesthesia is necessary. A third way of removing a large or stubborn foreign body is to push the material back through the nose into the nasopharynx. If the decision is made to push a foreign body into the pharynx, a general anesthetic should be used and an endotracheal tube should be placed in the trachea. In this way, when the foreign body is pushed into the nasopharynx, it is not aspirated and does not become a lethal foreign body in the larynx. Foreign Bodies in the Throat
The most common type of foreign body in the throat is bone, usually from fish or chicken. The bone is most often lodged at the base of the tangue, usually in an adult. Generally, there is a sensation of something being stuck in the throat. The patient can usually indicate the side that is affected and can give a vague description of the location of the bone. Most patients have few other symptoms. The region of the tonsils and tonsillar fossa must be examined carefully. When a fishbone is lodged in a tonsillar mass, it may appear to be mucus. The base of the tangue must be examined by the use of a mirror. In addition, palpation of the tonsillar region may be helpful in locating the foreign body. This examination requires a light-a head mirror or some source such as the headlight used in tonsillectomy. Acute total obstruction of the larynx, commonly known as a cafe coronary, is usually seen in middle-aged or older people who have been drinking and are eating meat. The piece of meat goes into the larynx, totally obstructing it, and these patients slump over as though having a heart attack. They really do not choke, and they cannat make any noise because the
STEPHEN G. HARNER Dr. Harner is a consultant, department of otorhinolaryngology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
larynx is totally obstructed. The only treatment is an emergency tracheostomy to provide an airway. Removing the food by reaching into the back of the pharynx and larynx is almost impossible; to try is generally a waste of time. The treatment of foreign bodies in the throat is removal. Removal of foreign bodies in the region of the tonsil and base of the tangue requires little special equipment. For foreign bodies that cannat be reached, direct laryngoscopy is indicated. Summary
Foreign bodies of the ear should be removed by irrigation, suction, or forceps. General anesthesia may be necessary. Foreign bodies of the nose should be removed with suction or forceps, and sometimes intubation may be necessary. Most foreign bodies in the throat can be removed by use of a mirror and a long hemostat. Address reprint requests to Stephen G. Harner, MD, Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN 55901. For ReadySource on ENT, see page 162. Overall self-test on ENT begins on page 154.
~_io_n______________~~__ a_nmcr The classic clinical finding for a foreign body in the nase is a. Epistaxis b. Nasal obstruction c. Unilateral nasal discharge d. Bilateral nasal discharge
Vol. 57 • No. 6 • May 1975 • POST8RADUATE MEDICINE
c
83
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Foreign Bodies in the Ear, Nose, and Throat Stephen G. Harner To cite this article: Stephen G. Harner (1975) Foreign Bodies in the Ear, Nose, and Throat, Postgraduate Medicine, 57:6, 82-83, DOI: 10.1080/00325481.1975.11714047 To link to this article: https://doi.org/10.1080/00325481.1975.11714047
Published online: 07 Jul 2016.
Submit your article to this journal
Article views: 1
View related articles
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20
• What are the three basic methods of removing a foreign body from the ear? • What is the classic finding that indicates a foreign body in the nose? • ln what part of the throat do bones most often become lodged?
STEPHEN G. HARNER, MD Mayo Clinic and Mayo Foundation Rochester, Minnesota
Foreign Bodies in the Ear, Nose, and Throat Foreign Bodies in the Ear
Foreign bodies inserted into the ear can be any size or shape and of any material. The size is limited by the size of the externat ear canal, and the material nearly always is wedged into the canal or nearly fills it. The size and shape of the foreign body should be determined, because this information is needed in deciding the easiest method of removal. The methods of removal fall basically into three categories. The first and easiest is to wash the material out. This is especially good for removal of earwax. The second method is suctian; often the foreign body can be removed with the suction tip alone. The third method is to use one of the many types of forceps. Many foreign bodies in the ear can be removed without the use of anesthesia, but if the patient is not cooperative or if the manipulations are painful, sorne type of anesthesia is needed. In the adolescent or adult, injection of lidocaine in the externat ear canal may be suffident. However, since most patients with foreign bodies in their ears are less than 6 years old, such injections are not possible. The child should not be sedated, because sedation does not provide anesthesia, and although the child
82
may be relaxed, as soon as his ear is touched he will move, which could cause much damage from the instruments. Therefore, general anesthesia is best. Removal of a foreign body from the ear is not an emergency and can be undertaken later in the same day or the next day. The patient who is given a general anesthetic usually does not require intubation and thus can be treated as an outpatient. Foreign Bodies in the Nose
The usual history is one of a child voluntarily inserting something into the nose. Any child who has unilateral purulent drainage from the nose must be suspected of having either a choanal atresia or a for~ign body in the nose. The latter is the more common. Examination of the nasal cavity usually reveals the nature of the foreign body. If there is much drainage and there is doubt about whether or not a foreign body is present, sinus roentgenograms may be of sorne benefit if the foreign body is radiopaque. As with foreign bodies in the ear, succion is often effective, probably more so in the nose than in the ear. Forceps removal is the most effective method. If succion or forceps are to be
POST8RADUATE MEDICINE • May 1975 • Vol. 57 • No. 6
used, usually no anesthesia is necessary. A third way of removing a large or stubborn foreign body is to push the material back through the nose into the nasopharynx. If the decision is made to push a foreign body into the pharynx, a general anesthetic should be used and an endotracheal tube should be placed in the trachea. In this way, when the foreign body is pushed into the nasopharynx, it is not aspirated and does not become a lethal foreign body in the larynx. Foreign Bodies in the Throat
The most common type of foreign body in the throat is bone, usually from fish or chicken. The bone is most often lodged at the base of the tangue, usually in an adult. Generally, there is a sensation of something being stuck in the throat. The patient can usually indicate the side that is affected and can give a vague description of the location of the bone. Most patients have few other symptoms. The region of the tonsils and tonsillar fossa must be examined carefully. When a fishbone is lodged in a tonsillar mass, it may appear to be mucus. The base of the tangue must be examined by the use of a mirror. In addition, palpation of the tonsillar region may be helpful in locating the foreign body. This examination requires a light-a head mirror or some source such as the headlight used in tonsillectomy. Acute total obstruction of the larynx, commonly known as a cafe coronary, is usually seen in middle-aged or older people who have been drinking and are eating meat. The piece of meat goes into the larynx, totally obstructing it, and these patients slump over as though having a heart attack. They really do not choke, and they cannat make any noise because the
STEPHEN G. HARNER Dr. Harner is a consultant, department of otorhinolaryngology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
larynx is totally obstructed. The only treatment is an emergency tracheostomy to provide an airway. Removing the food by reaching into the back of the pharynx and larynx is almost impossible; to try is generally a waste of time. The treatment of foreign bodies in the throat is removal. Removal of foreign bodies in the region of the tonsil and base of the tangue requires little special equipment. For foreign bodies that cannat be reached, direct laryngoscopy is indicated. Summary
Foreign bodies of the ear should be removed by irrigation, suction, or forceps. General anesthesia may be necessary. Foreign bodies of the nose should be removed with suction or forceps, and sometimes intubation may be necessary. Most foreign bodies in the throat can be removed by use of a mirror and a long hemostat. Address reprint requests to Stephen G. Harner, MD, Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN 55901. For ReadySource on ENT, see page 162. Overall self-test on ENT begins on page 154.
~_io_n______________~~__ a_nmcr The classic clinical finding for a foreign body in the nase is a. Epistaxis b. Nasal obstruction c. Unilateral nasal discharge d. Bilateral nasal discharge
Vol. 57 • No. 6 • May 1975 • POST8RADUATE MEDICINE
c
83
