Removal of Airway Foreign Bodies
What is considered a “foreign body”?
An object is considered a “foreign body” if the object is in a location in the body where it is not normally found. Common foreign bodies found in children include coins, small toys, foods (like peas, beans, nuts, or even candy), and, other small objects (like beads or pills, for example). Occasionally dislodged teeth or yes, even bugs, may be found. Probably the most concerning object is a button type battery (like camera and watch batteries), as these can leak harmful substances.
Common locations of foreign bodies include the ear, airway, or anywhere along the gastrointestinal tract (tubes which pass into the stomach and intestines), among other locations.
How are foreign bodies discovered?
Often a parent or other caretaker will see the foreign body being placed by the child and will bring the patient to the emergency room or pediatrician. In other instances, the symptoms noted in the patient will point to the possibility of a foreign body. Through various tests or procedures, this can be confirmed.
Foreign bodies in the ear usually lead to ear pain, hearing loss or drainage. Airway foreign bodies can cause noisy breathing, difficulty breathing or even recurrent pneumonia (lung infection). When objects are lodged in the swallowing tube, children may have excessive drooling or stop eating or drinking.
Do foreign bodies always need to be removed?
Some foreign bodies, such as those swallowed into the gastrointestinal tract, may pass out of the body along with a bowel movement and do not cause any significant problems. However, a suspected foreign body should always be investigated.
The focus of an ear, nose, and throat specialist is possible foreign bodies of the ear, nose, throat, and airways. If a foreign body is lodged in any of these areas, it is important to have it removed, as there is no natural way for these to pass out of the body. Additionally, there are complications associated with the objects if they remain in the abnormal location.
The remainder of this discussion will discuss how foreign bodies are removed from the ear, nose, throat, and airways.
What are the symptoms associated with a foreign body in the ear canal?
The type of object and how long it as been in the ear canal make a difference in the type of symptoms.
Generally, the symptoms can range from little to no discomfort to a lot of inflammation, pain, and discharge. The longer the object goes unrecognized, the more inflammation can occur. Hearing loss can be present due to blockage of the ear canal.
Who can remove a foreign body in the ear canal?
Usually, removing a foreign body in the ear canal is not an emergency and can be done by anyone experienced in this type of procedure. However, the ear, nose and throat specialist has special tools to remove foreign bodies without causing pain or damage to the ear. Inexperience in removing the object can cause more inflammation and make it harder for removal.
General anesthesia is not usually required for removal, although young or frightened children may benefit from this painless technique.
Batteries should be removed as soon as possible to avoid permanent damage to the ear canal and/or ear drum (tympanic membrane), so general anesthesia may be required depending on the age and cooperation of the patient.
How is a foreign body in the ear canal removed?
It is important that the patient remain very still while the procedure is performed. Holding the patient still is done with a parent and a medical assistant. We do not use restraints on children. There are a variety of methods used in removal depending on the size, shape, and location of the object. You may see attempts at removal using suction (like a vacuum cleaner) or different types of forceps (tweezers) to grab and pull the object out. Other methods that have been used successfully in removal are a magnet (for metal objects), and even superglue (on the end of a stick applicator).
As mentioned above, if the removal is emergent, has been unsuccessful, or the patient is significantly uncooperative, general anesthesia may be used.
The ear canal and eardrum will be examined after the procedure to determine if antibiotic ear drops may be of benefit. A hearing test will also be performed after removal.
Are there any complications from this procedure?
The complications related to leaving the object in the ear canal far outweigh the complications associated with its removal. That said, some common complications can include irritation and bleeding from the ear canal and damage to the ear drum (tympanic membrane).
What are the symptoms of a foreign body in the nose?
The most common complaint associated with a foreign body in the nose is a very bad smelling discharge from the nose, usually on one side. Sometimes the patient will have a history of one-sided sinusitis over several weeks or months.
Who can remove a foreign body from the nose?
As with objects in the ear, some types of objects can be removed by an experienced practitioner. More commonly, an ear, nose and throat specialist is involved, especially if there is a higher possibility of pushing the object back into the throat and getting into the airway or the object is a battery that can leak harmful substances and damage the area.
How is a foreign body removed from the nose?
As with the ear canal, the patient must be very still during the procedure.
The parent and a medical assistant will help the doctor remove the object. A medicine that helps control bleeding may be used in the nose. Both suction (like a vacuum cleaner) or forceps or hooks (to grab the object) may be used.
In the case of harmful materials or batteries, removal is usually performed as soon as possible by an ear, nose, and throat specialist in the operating room. After the object’s removal, nasal endoscopy (looking at all the surrounding area through a small tube like instrument) may be carried out to look for any further damage.
What are the complications of this procedure?
Some slight bleeding from the involved nostril usually accompanies removal. Damage to the nasal passages could also occur. Other complications can include pushing the object further backward in the nasal passage, with the possibility of having it lodge in the airways. However, an ear, nose, and throat specialist has the expertise in managing this type of complication should it occur.
THE AIRWAYS (throat to bronchi)
The back of the mouth or upper throat (the area visible when you open your mouth wide) can occasionally have a foreign object such as a fishbone stuck in the tonsils. These are usually easily visualized and removed by spraying an anesthetic (numbing) spray into the back of the throat. The tongue is held down and forceps are used to grab and pull out the object.
NOTE: The rest of this discussion will discuss removal of foreign bodies that are not visualized by just opening the mouth, but instead require the use of special instruments to visualize and remove the object.
What are the symptoms of foreign bodies located in the airways?
The symptoms depend on the location of the foreign body in the airway.
The size and shape of the object also affect the severity of the symptoms.
Please see BREATHING DIFFICULTIES for detailed information. A chest x-ray may also confirm the presence of a foreign body in the airway; however, a chest x-ray may not show anything, as not all objects can be seen on an x-ray.
Who can remove foreign bodies located in the airways?
Ear, nose, and throat specialists, who have extensive training and experience in this procedure, should remove objects that lodge in the airways. In children, these specialists are designated as pediatric otolaryngologists. Many times, pediatric pulmonologists (lung doctors) help decide whether your child’s symptoms are due to a foreign body or represent conditions like asthma.
How is a foreign body removed from the airways?
If a foreign body is suspected in any part of the airway, a BRONCHOSCOPE will be used to confirm the presence of and remove the object. A bronchoscope is a tube like instrument that allows the doctor to see and remove the foreign body with many different specialized instruments. It is called rigid bronchoscopy as opposed to flexible bronchoscopy, which is done with a flexible tube. (Please see EVALUATION OF THE AIRWAYS for more information on bronchoscopy).
The patient must be in an operating room “asleep” (under general anesthesia) during a rigid bronchoscopy. An instrument called a laryngoscope is placed in the patient’s mouth to hold down the tongue and to visualize the opening of the airway. The bronchoscope is then passed into the airway. The anesthesiologist (sleepy air doctor) can then help the child breathe at the same time the ear, nose and throat doctor is working. Once the object is seen, forceps (tweezers) can be passed through the bronchoscope to grab the object and pull it out. As some objects may break into smaller pieces (especially true with food particles), insertion and removal of the bronchoscope may be performed several times to ensure all the objects are removed before ending the procedure.
What are the complications of rigid bronchoscopy?
Complications that can be associated with this procedure include bleeding, problems with the heart rhythm, difficulty breathing, and possible damage to the teeth. Please see BRONCHOSCOPY for more information.
Thomas M. Andrews
Dr. Andrews specializes in the medical and surgical treatment of ear, nose and throat disorders of children and adolescents. His accreditations include Florida State Medical License and Ohio State Medical License. He is also a board member of the National Board of Medical Examiners and American Board of Otolaryngology, Head and Neck Surgery