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Foreign Body in Ear, Nose and Throat

Introduction

Foreign body is often accidentally inserted, swallowed or aspirated/inhaled and is not common in adult.

Foreign body can accidentally inhaled/aspirated and stuck in the airways and lung. This is most dangerous situation and require urgent medical attention.

Foreign body can accidentally swallowed and stuck either in the throat or food passage (esophagus).

Foreign body in the ear and nose is less dangerous and less common in adult.

In general, Foreign body can be divided into two types :

This type of foreign body produced more inflammatory reaction and higher risk of infection.

This cause less local reaction except certain material which contain chemical such as button batteries.

Causes

Foreign body in the airway / lungs :

  • Objects that tend to stay in the mouth for a long period of time, such as gum, sunflower seeds, or hard candy, safety pin had increase risk of being inhaled.
  • Eating while lying supine, especially just prior to falling asleep, increases risk of aspiration.
  • Factors that increase risk are underlying primary neurologic problems, such as senile dementia, mental retardation, fit/epilepsy, strokes, and parkinsonism. Conditions that depress the brain function such as alcohol, narcotics, barbiturates, or benzodiazepines, can increase likelihood of aspiration.

Foreign body ears :

  • Majority of objects found in the ears are accidentally placed such as dislodged tip of cotton bud while cleaning the ear.
  • Insects are well known to crawl into the ear, usually when asleep. Sleeping on the floor or outdoors would increase the chance of this unpleasant experience.

Signs & symptoms

Foreign body in the airway & lungs

  • Choking or coughing, difficulty in breathing and noisy breathing (inspiratory stridor or expiratory wheezing).

Foreign bodies in the throat

  • Foreign body sensation, especially after eating chicken or fish, although a variety of other objects may be involved.
  • Variable degrees of discomfort, from minor to more severe, such as drooling or an inability to swallow.
  • Person can usually localize the foreign body sensation in the throat.

Foreign bodies in food passage (esophagus)

  • There are usually presented acutely, with a history of difficulty in swallowing or while having meal. Inability to handle saliva indicate complete obstruction.
  • Person with dentures can accidentally swallowed that while in activity other then eating.

Foreign body in the ear

  • Most people can tell if there is something in their ear because the ear canal is very sensitive especially at the ends near the eardrum. The symptoms is largely depend on the size, shape, and substance involved.
  • Pain is the most common symptom. If the object is blocking most of the ear canal, you may experience a decrease in hearing on that side.
  • Additionally, irritation to the ear canal can also make you nauseated, which could cause you to vomit.
  • Bleeding is also common, especially if the object is sharp or if you try to remove it by sticking something else into your ear.
  • One of the most distressing situation is having a live insect in the ear. The insect’s movement can cause a buzzing in the ear and may be quite uncomfortable.
  • A foreign body in the ear can also damage the eardrum, which may or may not affect hearing.

Complications

Foreign body in the airway

  • Can result in a spectrum of changes, from minimal symptoms, often unobserved, to respiratory compromise, failure, and even death.
  • Lungs infections (pneumonia).
  • Collapse lungs.

Foreign body in the throat.

  • Abrasions, lacerations, and punctures, with associated abscesses, perforations, and soft-tissue infections.

Foreign body in the food passage (esophagus).

  • Abrasions, punctures, and perforations, with resultant injuries or infections in the chest or even vascular injuries to the aorta or pulmonary vasculature.

Foreign body in the ear.

  • Perforated ear drum.
  • Infection of ear canal with ear pain, discharge and hearing loss.

Treatment

Foreign body in the airway

  • This require urgent treatment
  • Foreign body will be removed under general anesthesia with rigid bronchoscopy by an ENT doctor

Foreign body in the throat

  • This require urgent treatment especially if it completely block with severe pain on swallowing.
  • The treatment will be based on the location of the foreign body.
  • Foreign body in the throat usually can be removed in the Clinic by an ENT doctor.
  • Lower in the food passage may require removal under general anesthesia with rigid instrument.

Foreign body ear

  • In the majority of cases, foreign body in the ear will not be life threatening. The urgency of the situation primarily depends on the location of the object and the substance involved.
  • Button batteries can decompose enough in the body to allow the chemicals to leak out and cause a burn. Urgent removal is advised.
  • Early removal is also recommended for organic material (such as beans) because these will swell when moistened.
  • Urgent removal is indicated if the object is causing significant pain or discomfort.

Most cases can usually wait until the morning or the following day for removal.

  • Putting something blindly into your ear is usually results in pushing any object deeper into the ear canal. This not only can damage the eardrum, but also make ultimate removal of the object more difficult.
  • In case of live insect in the ear, it is usually safe to place a few drops of mineral oil into the ear even though you do not have a known hole in ear drum. This will kill the bug and allow you to calmly and safely get to a ENT doctor.
  • All foreign body ears is best to have it removed by a ENT doctor who can view the object with proper lighting and instruments. Removal under sedation or anesthesia may be necessary in certain situation.
  • Organic foreign bodies in the ear shouldn’t be removed with syringing. This will cause the foreign body to swell up.

Prevention

Foreign body in the airway

  • Avoid putting any object in between teeth while doing other task.
  • Do not talk or laugh when there is something in the mouth .
  • Do not eating while lying supine especially just prior to falling asleep.

Foreign body in the food passage

  • Always make sure your denture is well fitted and does not loose.
  • Eat slowly will prevent unwanted foreign body (fish or chicken bone).

Foreign body in the ear

  • Never put anything in your ear
  • Insects are well known to crawl into the ear, usually when asleep. Sleeping on the floor or outdoors would increase the chance of this unpleasant experience.
Last reviewed : 26 April 2012
Writer : Dr. Iskandar Hailani
Reviewer : Dato’ Dr. Narizan Ariffin