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ENT foreign bodies (Ear (Management (Conservative
Crocodile forceps under…
ENT foreign bodies
Ear
Management
Conservative
Crocodile forceps under direct vision (soft FBs)
Hook/probe under direct vision (hard FBs)
Irrigation (soft/hard FBs; drown insects in oil)
Surgical
Indication: unable to remove conservatively; embedded earrings
MOA: removal under GA (internal FBs), local block (earrings)
Diagnosis
History
HPC: mechanism, symptoms
Examination
Internal (auroscope): FB, trauma
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Pathophysiology
Insects, vegetation, inert objects
Deliberate or accidental
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Nose
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Diagnosis
History
HPC: what, when, inserted elsewhere
Examination
Internal (auroscope): FB, trauma
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Management
-
Conservative
Refer ENT (risk aspiration)
Child blow nose
Parental kiss (blow into child's mouth
while occluding the other nostril)
Ingested
Epidemiology
Children, adults with mental health problems
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Pathophysiology
Physiology
Radiopaque (coins, rings) radiolucent (pen tops)
If it gets to the stomach, its likely to pass rest of the way OK (apart from button batteries)
Dangerous items
Batteries, open pins, razor blades
Magnets (can attract each other through bowel and perf)
Fish bones (can impact in pharynx/oedophagus)
Food bolus (often meat, unable to swallow)
Diagnosis
History
HPC: what, when, how, symptoms
PMH: psychiatric illness, prev episodes
Examination
ENT: direct visualisation using headtorch (impacted items)
Abdo: may have pain, peritonism (if perf)
Investigations
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Imaging
X-ray - lateral neck, CXR (radiopaque)
Management
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Definitive
Conservative
Refer to general surgery if dangerous item,
symptomatic, or may be impacted
Visible impacted items removal with Tilly's forceps
Others can do stool examination if sentimental item
Surgical
Indication: dangerous item, symptomatic, impaction
MOA: endoscopy and removal
Throat
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Diagnosis
Examination
Resp: stridor/cough, chest sounds often normal
but may have reduced breath sounds
Investigations
Imaging
CXR: radiopaque mass, may have
distal consolidation and hyperinflation
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