Pharyngeal foreign bodies are foreign objects, living organisms or parts of food that have accidentally entered the pharynx. Under the influence of foreign bodies, the pharyngeal mucosa is damaged. They also often lead to obturation of the upper respiratory tract and infection, resulting in asphyxia. Foreign bodies of the pharynx are manifested by perspiration, severe sore throat, urge to vomit, feeling of a foreign object, increased salivation, violation of swallowing. There is a violation of breathing. Diagnosis of pharyngeal foreign bodies is based on the results of X-ray examination, anamnestic data and pharyngoscopy. The essence of treatment is to remove foreign bodies of the pharynx surgically or naturally.
The content of the article:
Classification of pharyngeal foreign bodies
Symptoms of pharyngeal foreign bodies
Diagnosis of pharyngeal foreign bodies
Complications of pharyngeal foreign bodies
Removal of foreign bodies of the pharynx
Foreign bodies of the pharynx
The pharynx plays an important barrier role, thanks to which foreign bodies will not enter the digestive tract or respiratory tract. This is due to the contraction of the pharyngeal muscles at the reflex level. Sensitive receptors of the mucous membrane play a role in this.
Domestic foreign bodies of the pharynx are most often localized:
in the palatine tonsils;
side rollers;
the back wall of the oropharynx;
epiglottal pits;
pear – shaped sinuses;
lingual amygdala.
Basically, these are objects and bones that can get into the oral cavity along with food. Another reason for getting foreign bodies is inattention while eating, laughing or talking. Also, small objects such as pins, nails, screws, etc. fall into the mouth when they are held in the lips. In young children, a certain object can get into the larynx or nose due to the inattention of adults. In older people who have removable dentures, some of them can also get into the pharynx.
Often, the ingestion of foreign bodies into the throat is caused by mistakes of medical workers when performing certain manipulations. So, it can be cotton swabs, parts of medical instruments and the like. If we talk about living organisms, they can get into the pharynx retrograde from the patient’s intestines, with inhaled air and with non-boiled drinking water.
Classification of pharyngeal foreign bodies
Foreign bodies of the pharynx are divided depending on which part of the pharynx they are located in. So, there are three parts of the pharynx:
upper — nasopharynx;
the middle one is the oropharynx;
the lower one is the larynx.
Most often there are foreign bodies of the larynx and oropharynx. Foreign bodies in the nasopharynx are localized very rarely, their entry into this part is due to paralysis of the soft palate. This phenomenon occurs under the influence of pathological processes of the brain stem (hemorrhagic and ischemic stroke, syringomyelia, neurosyphilis, tumors, etc.).
Pharyngeal foreign bodies by their nature can be food, household, living and iatrogenic. In most cases, there are foreign bodies of the pharynx, which are parts of food — meat and fish bones, poorly chewed pieces of meat and the like. Screws, nails, sewing needles, pins, buttons, dentures, pieces of glass or wood, small toys or their parts, coins are usually observed among household foreign bodies of the pharynx. Iatrogenic foreign bodies of the pharynx are dental drills, tampons, fragments of medical needles and other instruments used by dentistry, otolaryngology and surgery.
As a rule, the ingress of foreign objects into the throat is possible when:
treatment of caries;
tooth extraction;
prosthetics of teeth;
tonsillectomy and second operations;
removal of benign tumors of the nasal cavity and pharynx;
performing an adenotomy.
If we talk about living foreign bodies, then they can include:
ascarides (penetrate from the intestine);
leeches (get into the throat together with water when bathing in open reservoirs or when drinking);
various insects that a person accidentally inhales while breathing, sometimes they can even get into the esophagus.
Also, petrifications are considered foreign bodies of the pharynx, which are formed during the calcification of the caseous (curd) contents of the crypts of the palatine tonsils.
In addition, foreign bodies of the pharynx are divided into exogenous and endogenous, depending on their origin. Endogenous foreign bodies enter the pharynx in an ascending way or are formed directly in it. These are ascarids, which migrate from the intestine through the stomach and esophagus to the pharynx, and petrificates, which are formed in the crypts of the palatine tonsils. Exogenous foreign bodies of the pharynx enter it from the outside through the nose or through the mouth. In otolaryngology, according to the depth of penetration into the pharyngeal tissues, deeply penetrating and superficial foreign bodies of the pharynx are separated.
It is worth noting that each of the types of foreign bodies manifests itself in different ways.
Symptoms of pharyngeal foreign bodies
The symptoms of pharyngeal foreign bodies directly depend on their shape, size, placement, type and time spent directly in the pharynx. Common symptoms are: sensation of a foreign body in the throat, sore throat, increased salivation, tickling, difficulty swallowing, pronounced cough. There is also an irradiation of pain in the larynx or ear. The urge to vomit is noted when a foreign body is localized in the oropharynx. An object caught in the throat, in some cases, passes into the larynx or esophagus. It is worth noting that at the same time it damages the mucous membrane of the pharynx, which is accompanied by tickling and sore throat.
In most cases, sharp objects are concentrated in the oropharynx. They get stuck in the amygdala of the tongue root, lacunae and brackets of the palatine tonsils. With foreign bodies of the pharynx of this type, there is a pronounced pain syndrome. Pain of a stabbing or cutting type is also characteristic, which increases when swallowing, breathing movements and talking. Quite often, acute foreign bodies cause spasm of the pharyngeal muscles, as a result of which the patient is unable to perform swallowing movements, drink water and eat. Severe muscle spasm and pain provokes a violation of swallowing. In addition, saliva is not swallowed, but flows out of the oral cavity, which negatively affects the lips, maceration and inflammation occur.
Also, blunt foreign bodies fall into the oropharynx, which are located above the entrance to the esophagus or larynx. If we talk about large foreign bodies of the pharynx of similar localization, then they can partially block the lumen of the larynx, resulting in respiratory distress. Complete obstruction of the entrance to the larynx provokes asphyxia, air does not enter the respiratory tract. Most often, the cause of asphyxia are elastic foreign bodies of the pharynx, which, when they enter the larynx, do not leave cracks, so air does not pass.
You should especially be careful if a foreign body got into the throat of a child. It is possible that he will not tell anyone about what happened for a long time. Therefore, you need to pay attention to the lack of appetite, passivity, impaired salivation, unpleasant grimaces during swallowing, regular urge to vomit.
Diagnosis of pharyngeal foreign bodies
As a rule, foreign bodies of the pharynx, which are localized in the oropharynx, are diagnosed without complications. It is more difficult to identify small foreign bodies of the pharynx or objects in the folds of the mucous membrane. This also applies to foreign bodies in the area of the larynx, especially if they are located in the area of the scooped folds, in the pear-shaped sinuses or between the epiglottis and the root of the tongue.
To improve the results of the diagnosis of foreign bodies of the pharynx, pharyngoscopy is used. In addition, if necessary, an X-ray examination is carried out. Radiography is used to determine the focus of pathology.
If there is a threat of migration of a foreign body into the nasal cavity, larynx or esophagus, it is indicated:
laryngoscopy;
rhinoscopy;
radiography of the esophagus with contrast;
esophagoscopy.
According to the existing statistics, when patients apply for foreign bodies of the pharynx, about half of them are not detected. Very often there are numerous injuries of the pharynx due to attempts to self-remove a foreign body. Such complaints may be caused by tumors of the pharynx, inflammatory processes (tonsillitis, pharyngitis), excessive suspiciousness of the patient, neuropsychiatric disorders. This also applies to pathological changes in the cervical vertebrae (spondylosis, osteochondrosis), neuromuscular dysfunction, elongation of the styloid process.
Complications of pharyngeal foreign bodies
Even minor injury to the mucous membrane by a foreign body of the pharynx is accompanied by an inflammatory reaction, increased pain syndrome, the appearance of edema and hyperemia. Also, foreign bodies can cause deep and significant damage to the tissues of the pharynx.
Pharyngeal foreign bodies are often a source of infection, which can cause a lateral pharyngeal abscess, a pharyngeal or paratonsillary abscess.
Removal of foreign bodies of the pharynx
Any foreign body of the pharynx must be removed. If it is easily accessible and well visualized, an otolaryngologist can perform its removal in a polyclinic. To do this, use tweezers, nasal forceps or forceps of Brunings. After the foreign body is removed, the pharynx is treated with a Lugol solution. In addition, the patient is recommended to rinse with antiseptic solutions and take exclusively soft food.
Much more trouble is caused by foreign bodies of the pharynx, which are localized in the laryngeal part. To remove them, atropine is pre-injected to reduce salivation. This operation is performed under local anesthesia. Special laryngeal forceps and a laryngeal mirror are used.
Laryngoscopy is suitable for removing hard-to-reach foreign bodies. Pharyngeal foreign bodies located in soft tissues cannot be removed naturally. This also applies to those cases when edema occurs under the influence of a foreign body. In such situations, surgical removal is performed by opening the pharynx.
Urgent removal is necessary when a foreign object causes asphyxia and disrupts breathing. This is a direct threat to human health, so it is impossible to delay removal. It is recommended to examine the patient and try to remove the foreign body. If this cannot be done, you should contact a specialist as soon as possible. It is important that the patient remains calm and does not worry, otherwise the foreign body may move further.
