| disease | Foreign Body in the Pharynx |
Foreign bodies in the pharynx are one of the common emergencies in otolaryngology, easily detected and removed. If improperly managed, they often delay treatment and lead to serious complications. Larger foreign bodies or severe trauma can cause pharyngeal injury.
bubble_chart Etiology
1. Improper diet, swallowing unchewed food or foreign objects mixed in food such as fish bones, meat bones, fruit pits, etc.
2. Children playing, putting small toys, coins, etc. into their mouths, and the objects fall into the throat when crying, laughing, or falling.
3. Elderly people have poorer sensation in the throat, missing teeth, and insufficient chewing, making them prone to this condition.
4. Psychiatric patients, unconsciousness, drunkenness, epileptic seizures, pharyngeal muscle paralysis, suicide attempts, or incomplete anesthesia recovery may lead to swallowing foreign objects.
5. During head and neck trauma, foreign objects such as shrapnel may remain in the pharyngeal cavity.
6. Surgical hemostatic gauze, cotton balls, or suture needles accidentally left in the nasopharynx or tonsils during procedures. {|105|}
bubble_chart Clinical Manifestations
1. Nasopharyngeal foreign bodies: Relatively rare. More common in children, trauma, or accidental occurrences during surgery. Medical history is often unclear, frequently presenting with nasal obstruction symptoms, foul-smelling nasal discharge, and possible unexplained fever. May be complicated by eustachian tube inflammation, otitis media, etc. Examination can easily overlook and misdiagnose as fistula disease.
2. Oropharyngeal foreign bodies: Common. Foreign bodies often lodge in the tonsils, tongue base, or epiglottic vallecula, usually small and prone to embedding in tissues or hiding in hard-to-detect areas. Symptoms vary depending on the type and location of the foreign body, often manifesting as a stabbing pain in the throat, worsening during swallowing, with patients avoiding neck movement and able to pinpoint the painful area.
3. Hypopharyngeal foreign bodies: Mostly found in the pyriform fossa or postcricoid region. Symptoms resemble those of oropharyngeal foreign bodies, but due to their larger size, dysphagia is more common. Irritation of the laryngeal membrane may cause itching, cough, or even laryngeal membrane edema, hematoma, etc. If the laryngeal inlet is obstructed, there is a risk of asphyxia. Sometimes, actions like choking, swallowing, or vomiting may expel or push the foreign body further down.Examination: A tongue depressor for the oropharynx or indirect laryngoscopy can reveal the foreign body. Long-standing nasopharyngeal foreign bodies may show purulent nasal discharge, membrane congestion, or pus in the posterior part of the inferior turbinate. If the foreign body pierces or injures pharyngeal tissues, static blood or hematoma may be present, with inflammatory changes in surrounding tissues over time. Larger oropharyngeal and hypopharyngeal foreign bodies often present with palpable tenderness externally on the neck; pushing the larynx or trachea toward this area exacerbates the pain.
A detailed inquiry into the medical history and analysis of symptoms can lead to a preliminary diagnosis. Most patients have a history of swallowing a foreign body and the object is found during the physical examination. Some patients initially experience stabbing pain, but no foreign body is detected during the examination, which may be caused by mucosal abrasions. This symptom usually lasts for a short duration. For those with pain in varying locations, a persistent sensation of a foreign body in the throat, and seeking medical attention several days after onset, it is important to differentiate the condition from pharyngeal paresthesia or chronic pharyngitis.
bubble_chart Treatment Measures
Foreign bodies in the oropharynx, such as small objects in the tonsils or lateral pharyngeal wall, can be removed with forceps. For foreign bodies located at the base of the tongue, vallecula, or pyriform fossa, they can be extracted under indirect or direct laryngoscopy using foreign body forceps. Nasopharyngeal foreign bodies require initial palpation with a probe and X-ray examination to determine their position, size, shape, and hardness. The soft palate is then retracted, and the foreign body is removed with a postnasal angled forceps. During removal, the patient should be placed in a supine position with the head lowered to prevent the foreign body from falling into the lower respiratory tract or being swallowed. If pharyngeal infection has already occurred, antibiotics should be administered first to control the inflammation before removing the foreign body. For cases with parapharyngeal or retropharyngeal abscess formation, the abscess is drained orally or through a lateral neck incision, followed by foreign body removal.
Oropharyngeal foreign bodies generally have no adverse consequences, and the mortality rate of pharyngeal foreign bodies is less than 1%.
Same respiratory foreign body. If symptoms have already appeared, do not blindly attempt to remove it with fingers or try to swallow vegetables, steamed buns, etc., to push down the foreign object, as this may lead to serious consequences.
Foreign body-induced trauma or failure to remove it in time can lead to severe complications such as laryngeal edema, pharyngeal and cervical abscesses, subcutaneous abscesses, aspiration pneumonia, mediastinitis, sepsis, and massive hemorrhage.
