Fish bone in the throat


Fish bone in the throat

If you have swallowed a fish bone there will be pain and dysphagia. And also will be drooling of saliva. Attempted removal by putting finger might have caused further damage.
Chicken bone, bottle tops, bay leaf, pills, battery and coin are the other common foreign bodies stuck in the throat and commonly seen in the ENT clinics.

 

On examination

If symptoms are mild, test the patient’s ability to swallow, first using a small cup of water and then small piece of bread. See what symptoms are reproduced, or if the bread eliminates the foreign body sensation.
With the patient sitting in a chair, inspect the oropharynx with a tongue depressor, looking for foreign bodies or abrasions

Inspect the hypopharynx with a good light or headlamp mirror, paying special attention to the base of the tongue, tonsils and vallecula, where foreign bodies are likely to lodge. Maximize your visibility and minimize gagging by holding the patient’s tongue out (use a washcloth or 4×4″ gauze for traction and take care not to lacerate the frenulum of the tongue on the lower incisors) and have the patient raise his soft palate by panting. This may be accomplished without topical anesthesia, but if the patient is skeptical or tends to gag, you may anesthetize the soft palate and posterior pharynx with a spray (10% lidocaine spray) or by having the patient gargle with Xylocaine viscous.

A small fish bone is frequently difficult to see. It may be overlooked entirely except for the tip, or it may look like a strand of mucus. If the object can be seen directly, carefully grasp and remove it with Tilley forceps .Objects in the base of the tongue or the hypopharynx require a mirror or indirect laryngoscope for visualization.

Fiber optic nasopharyngoscopy is preferred when available.

Further treatment is probably not required, but you should instruct the patient to seek follow-up if pain worsens, fever develops, breathing or swallowing is difficult, or if the foreign body sensation has not totally resolved in 2 days.

X-ray neck

If you and your patient are not satisfied, you may proceed to a soft tissue lateral x ray of the neck. This will probably not show radiolucent or small foreign bodies, such as fish bones, or aluminum pop tops, but may point out other pathology, such as a retropharyngeal abscess, or severe cervical spondylosis, which might account for symptoms .Lateral soft-tissue x rays, can be very misleading because ligaments and cartilage in the neck calcify at various rates and patterns. The foreign body you see on a plain x ray may simply be normal calcification of thyroid cartilage.

Barium swallow-Contrast study

You may also want to proceed to a barium swallow, if available, to demonstrate with fluoroscopy any problems with swallowing motility, or perhaps coat and thus visualize a radiolucent foreign body. Remember that endoscopy is technically difficult after barium has coated the mucosa and possibly obscured a foreign body. It may be preferable to use a water-soluble contrast (e.g., Gastrographin) but even under the best of circumstances, contrast studies are of limited value.

Endoscopy

Rigid laryngoscopy, esophagoscopy, and bronchoscopy under general anesthesia for the few cases where your suspicion of a perforating foreign body remains high (e.g., when the patient has moderate to severe pain, is febrile or toxic, cannot swallow, is spitting blood, or has respiratory involvement.

Antibiotic cover

If X rays are negative and careful inspection does not reveal a foreign body, and the patient is afebrile with only mild discomfort, the patient may be sent home and observed.A short course of broad spectrum antibiotic is prescribed.

Reassure him that a scratch on the mucosa can produce a sensation that the foreign body is still there, but that if the symptoms worsen the next day or fail to resolve within two days he may need further endoscopy.
All patients who complain of a foreign body of the throat should be taken seriously. Even relatively smooth or rounded objects that remain impacted in the esophagus have the potential for serious problems, and a fish bone can perforate the esophagus in only a few days.

Impacted batteries represent a true emergency and require rapid intervention and removal because leaking alkali produces liquefactive necrosis. A pill, composed of irritating medicine (e.g., tetracycline) swallowed without adequate liquid, may stick to the mucosa of the pharynx or esophagus and cause an irritating ulcer. Bay leaves, invisible on x rays and laryngoscopy, have lodged in the esophagus at the cricopharyngeus and produced severe symptoms until removed via rigid endoscope.

The sensation of a lump in the throat (Globus Pharyngis), unrelated to swallowing food or drink, which is related to crico- pharyngeal spasm and anxiety. The initial workup is the same as with any foreign body sensation in the throat.