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Introduction: Foreign body in ear, nose and throat though being a common entity needs specific technique and condition to remove.
Methods: A retrospective descriptive study was done in patients presenting in a tertiary referral center. Demography along with site, type of foreign body along with its removal was recorded in a proforma.
Results: Out of total 211 cases recorded, 118 were male and 93 female. Most of them were less than five years. Most of the presentation was in nose (40.2%) followed by ear (34.1%) and throat (24.1%). Average duration of presentation in our hospital was 1.2 days with ten cases presenting after 1 week of insertion. Common foreign bodies in ear were grain seed (41.6%), Plastic bead (20.8%) and insect (13.8%). Common foreign bodies in nose were eraser (35.2%), Plastic bead (23.5%) and grain seed (18.8%). Throat foreign body comprises mainly coin (58.8%) and bone (39.2%). Removal was done in OPD setting in 87.5% of ear foreign body, and 96.4% of nasal foreign body. In case of throat foreign body, only 63.6% was removed in OPD setting and rest needed general anaesthesia for removal. All foreign bodies were removed within 24 hours of presentation in hospital.
Conclusion: Foreign bodies in ENT can be treated immediately without much morbidity and mortality if presented to an institution with otolaryngology services on time. Foreign bodies being more common in children warrants more watchfulness from family members.
Ear, nose and throat foreign bodies (FB) are common in otorhinolaryngological clinical practice. It is commonly seen in children who have habit of inserting nearby objects in their nose, ear or mouth. This can cause minor irritation to life threatening problem. Removal of FB requires good light, a co-operative or fully restrained patient and a gentle approach by the clinician. An accurate diagnosis of the FB should be made prior to attempts to remove it [1,2]. Increasing awareness of the prime health workers may be tried to reduce incidence of this risky health event. Capacity building of the primary level physicians to handle foreign body insertion cases can lessen the stress of the victim children and their parents .
Foreign body injuries constitute a significant portion of pediatric trauma in clinical practice. The under 3 years are most affected [3-5]. There is need for more public education of parents and care givers so as to prevent this avoidable injury [3,4,6]. In
most of the studies, ear foreign body was most common [4,5,7,8].
While in others, nasal FB was more common . There is past history of similar incidence in about one fourth of cases . In such cases underlying morbidity like glue ear, otomycosis, ear wax, allergic rhinitis, teething etc should be ruled out.
The type of foreign bodies varies with age group and site of foreign body lodgment. In general, common foreign bodies in both adult and children are food related while small objects such as stone, plastic object and eraser in pediatric group [5-7]. FBs in the ear and nose were found more frequently in children, and the throat was the most common site of FB in adults and elderly people. Most of the FBs can be easily removed in emergency room or outpatient department [8,9].
Sometime patient can present with FB in ear, nose and throat without history of insertion. In such case especially in children high degree of suspicion is required to diagnose. Correlation of symptomatology and demography with type of foreign body
may be helpful for implementing preventives measures and
better management of case. This study was designed to establish
the local data of Otorhinolaryngological foreign bodies in term
of prevalence among pediatric and adult groups, the clinical
features, types of foreign body at different sites, and laterality
of foreign bodies.
A descriptive cross sectional study was carried out in
Nepalgunj medical college at Nepalgunj, a referral center for
midwestern and farwestern region of Nepal, from 1st Jan 2016
to 31st Dec 2016. Patients of all ages and sex presenting in
outpatient department (OPD) and emergency departments with
history of foreign body insertion or those who underwent FB
removal were evaluated and case entered into proforma sheet.
The cases were analyzed according to demography, nature and
type of FB. Patient who didn’t have FB presence during detail
examination and relevant investigations or those who didn’t
allow removal in our hospital were excluded from study. Ethical
approval was taken from Ethical committee. Comparison was
done between types of FB and demography of patient. Data wasanalyzed using SPSS 17th version. Descriptive statistics was
presented including mean, SD, frequency and percentage.
There were 211 cases recorded, out of which 118 were male
and 93 female. Commonest age group irrespective of type and
site of foreign body was less than five years. It accounts 50.2% of
total cases followed by 5-15 years (22.7%), 15-30 years (18.9%)
and more than 30years (8.0%). Most of the presentation was in
nose (40.2%) followed by ear (34.1%) and throat (24.1%). There
were 3 recorded cases of foreign body in neck and face region.
All patients presented within a day to nearby center when
they suspect foreign body insertion. Average duration of
presentation in our hospital was 1.2 days. There were ten cases
who presented after 1 week of insertion. Two of them couldn’t
come to hospital in time due to transportation difficulty while
remaining eight were held in local health center with medication
and alternative removal methods. Out of ten, only one was in
throat while five were in nose and four in ear. There were past
history of foreign body insertion in two patients. Both of them
had nasal foreign body in past.
Different types of foreign body in ear, nose and throat
has been presented in (Table 1). Average age of foreign body
insertion in ear was 3.5 years while that of nose was 2.8 years.
Regarding throat it was 23.2 years. Right ear (62.5%) and left
nostril ((56.4%) were common sides. Common foreign bodies
in ear were grain seed (41.6%), Plastic bead (20.8%) and insect
(13.8%). Common foreign bodies in nose were eraser (35.2%),
Plastic bead (23.5%) and grain seed (18.8%). Throat foreign
body comprises mainly coin (58.8%) and bone (39.2%). There
were 2 cases with foreign body in neck which were accidental
insertion of metallic pin. There was a case of thorn insertion in
face presenting as discharging sinus.
Few people were not aware of foreign body inserted in
their body. There were various ways of presenting such cases
as depicted in (Table 2). Nasal discharge or ear discharges
were common presentations when patients were not aware of
it. Removal was done in OPD setting in 87.5% of ear foreign
body, and 96.4% of nasal foreign body. In case of throat foreign
body, only 63.6% was removed in OPD setting and rest needed
general anaesthesia for removal. Regarding neck and face
foreign body exploration was done in general anaesthesia. All
foreign bodies were removed within 24 hours of presentation
Foreign bodies are emergency ENT condition [10,11]. If
not attended at time it can lead to hazardous complications
. Around 94% cases presented immediately on suspecting
foreign body insertion and they got it removed within 24 hours
of presentation as in Malaysian study . It is the concern
regarding remaining 6% cases that were held unnecessary in
a center, where it couldn’t be removed. It indicates necessity to
educate local health professional for better management .
Although there might have been lot more cases where FB was
removed by primary health professionals and who need not have
to reach our center; but we need to decrease those cases who
suffered unnecessarily due to improper guidance.
Foreign bodies in the aero digestive tract tend to present
earlier as it cause extreme discomfort . There was a
significantly higher proportion of foreign body in the right ear
as in Hon study  but contrasting in case of nose. Mean age
was 5.7 years in this study which was comparable to most of
the studies [3,6,9] but lower as compared to Shrestha study
(21.2years)  ;while male predominance was seen in all these
studies. Children being inquisitive of their body part may be
exploring and putting things in their orifice. Foreign body of the
ear was found to be most frequent in some studies [2,8,9] but in
our study it was more common in nose as in Mukherjee study 
and Ibekwe study .
The increased risk of FB aspiration in children is due to
the different structure of the pharynx and the upper airways
compared to adults. In addition, children have an immature
swallowing mechanism and they most commonly aspirate food
stuffs. FB aspiration is usually a sudden and dramatic event
when the child feels that he is suffocating or choking . There
were just 3 cases of FB bronchus presented in our hospital;
which couldn’t be removed due to lack of proper instruments.
All three of them were immediately referred to nearby branch of
same hospital, where timely intervention saved their lives.
Past history was found in only 2 cases which was lower as
compared to Mukherjee study  but nasal foreign body was predominant in both study. Although there was no psychiatric
condition in our two cases, but it is advisable to rule out in
patients with repeated foreign body insertion. In contrast to
study done in Melanesian children  where ear foreign body
was commonest, we found nasal foreign body to be more
common. This difference may be culturally, socially directed and
availability of local substance. In our study commonest foreign
body overall is grain seed (21.8%) followed by metal (18.4%)
and plastic bead(16.5%).Although seed and plastic bead were
common in Melanesian children  study also, but stone which
was common in that study was not in ours.
Nasal foreign bodies are frequently encountered in the
emergency setting of ear, nose, and throat diseases. Although
they are not life-threatening conditions, they require urgent
intervention, as they may lead to several complications in the
long-term. Parents and caregivers of children should keep objects
which can be put into the nose away and be instructed that
they should consult a physician in case of nasal foreign bodies
[13,14]. There was a strong correlation between duration of FB
insertion and associated complications . Repeated failed
attempts and delayed referrals to Otorhinolaryngologists from
peripheral centers were also contributing factors to increased
morbidity and hence the need for awareness [15,16]. Although
there were no complications in our center during study period,
but we need to take necessary steps to avoid such occurrence.
Foreign bodies in ENT can be treated immediately without
much morbidity and mortality if presented to an institution with
Otolaryngology services on time. Foreign bodies being more
common in children warrants more watchfulness from family
members and one need to rule out FB in unilateral undefined
presentation in ear and nose.