F.

Bs in otolaryngology

Tarek Abdel Fattah (M.D) otolaryngologist Hearing & speech institute Cairo- Egypt

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)

Classification: Ear Nose Pharynx Larynx Trachea Esophagus

Ear foreign bodies

Types: -Animate: Ants, cockroaches, mosquitoes

- inanimate: 1. vegetable: beans,seeds,penuts. 2. Non vegetable: Beads, plastics, toy pieces, cotton, rubber

How to remove? position: child

infant

Instruments:

Depends on experience, type of F.B (Some time you need to be creative)

When we need G.A.? struggling child, irritable adult impacted or large F.B
Complications: - Trauma to Ext.A.canal. - T.M perforation - Ossicular disruption - Facial palsy PLZ dont try this at home

Nasal F.Bs

Types: -Animate - Inanimate: vegetable Non vegetable

When to suspect?
any child with unilateral, persistent, nasal obstruction & offensive nasal discharge

Imaging:

How to remove: position:

Instruments:

Complications: slip backwards to be inhaled PLZ dont try this at home

Pharyngeal F.Bs

Commonest F.Bs: - fish bones - chicken bones

large F.Bs cause dysphagia & drooling

Complications: finger sweeping of the F.B is extremely dangerous

PLZ dont try this at home

Laryngeal F.Bs

- 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 breathing Emergency maneuvers

PLZ we must all know how to do this at home

Tracheal F.Bs

Types:

When to suspect: - history of chocking & coughing Given by an adult or witnessed by parents of a child - Persistant chest symptoms.

Investigations: chest X-ray is most valuable

Instruments:

How to remove:

Esophageal F.Bs

Oro & hypopharynx 15 cm

Distance is measured from central incisor

Normal Constrictions

Oesophageal inlet: cricothyroid muscle

25 cm At crossing of aortic arch & left main bronchus

40 cm

At its end when it enters through the diaphragm

Conclusion: - Foreign bodies removal is the most interesting & rewarding( yet sometimes challenging) 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

The End
Thank You