Introduction
Foreign body presentations in otolaryngology clinics are common and 11% of these were in emergency room of ENT hospitals.1 An object is considered as a "foreign body" if the object is in a location in the body where it does not belongs. Foreign body may be classified as living and nonliving. The non-living Foreign body can be classified as vegetative and non-vegetative, and hygroscopic and non-hygroscopic. Paediatric population were more commonly suffered from the ENT foreign bodies although adults were also suffered. 2 Presence of foreign bodies requires prompt diagnosis and early treatment by experts otherwise can cause increased morbidity and mortality along with cost burden. 3, 4, 5 Earlier studies have been done to find out the prevalence, diagnosis, treatment and complication related to ENT foreign bodies, 6 However in recent past none of the studies were conducted in our tertiary care centre. Hence this study will plan to find out the prevalence among paediatric and adult population.
Objective
To evaluate the prevalence of ENT foreign bodies in paediatric and adult population along with types of foreign bodies, its lodgment in different sites and important clinical findings.
Materials and Methods
The present study was conducted in ENT department, Chhindwara Institute of Medical Sciences, Chhindwara, Madhya Pradesh. Total number of patients attending the ENT OPD and causality were 354 between the study duration of May 2018 to May 2021 included in present study. In collected data, demographic evaluation in term of age, gender and occupation as well as different types of foreign bodies, their lodgment site and clinical features were evaluated after taking detailed history with careful ENT examination. The study protocol was approved by the Institutional Ethics Committee, Chhindwara institute of medical sciences, Chhindwara, Madhya Pradesh.
Results
In our study the maximum incidence were noted for foreign bodies of Nose 171 (48.3%) followed by 143 (40.3%) and 40 (11.3%) of Ear and Throat respectively.[Table 1, Table 2][Table 3] The occurrence of ENT foreign bodies were more common in 0-10 years of age in children with higher percentage of Nasal foreign bodies 158 (44.6%).[Table 1]The types of foreign bodies which were common in both the children and adults population were related to foodstuffs with addition of small size objects like plastic toy specially in children.
Nose
Clinical findings: History given by parents and relatives who saw the foreign bodies in the nose in which, 123(34.7%) cases presented with unilateral, purulent and foul smelling nasal discharge with few patients with blood stained, 38 (10.7%) cases presented with nasal obstruction and remaining 10(2.8%) cases presented with nasal bleed.
Types of foreign body: seeds or nuts are the most commonly presented foreign bodies in nasal cavities which consist of 67(39.2%), followed by stone 23 (13.4%), cotton/paper 17(9.9%), plastic 16(9.3%) cases, chalk 12(7.0%) cases, and metal 11(6.4%), maggots/insects 9(5.2%), thermacol 8(4.6%), wood 6(3.5%) and others in 2(1.1%) cases. [Table 4]
Ear
Clinical findings: Most of the patients were asymptomatic, rest of the patients presented with history of alleged foreign bodies in the ear presenting with complaints of ear itching, otalgia, otorrhoea, and blocked ear.
Types of foreign body: Cotton was the commonest ear foreign bodies encountered which consisted of 41 (28.6%) cases. This was followed by matchstick in 37 (25.8%) cases, insects in 28 (19.5%) cases, pencil tip in 19 (13.3%) cases, plastic toys or moti in 12 (8.4%) cases, seeds or nuts in 4 (2.7%) cases, and others in 2 (1.4%) cases. [Table 5]
Throat
Clinical findings: Most of the time patients were asymptomatic, history given by patient’s guardian shows suspicion of any missing object. Rest of the patients complains of pain during deglutition, foreign body sensation in throat and hyper salivation.
Type of foreign body: Fish bone 24(60%) is the most often found esophageal foreign body and tonsillar crypts is the most common site of lodgment followed by vallecula, base of tounge, pyriform fossa and least common in cricopharynx. Coin 12(30%) is the second most found foreign body in throat and its site of lodgment is cricopharynx.[Table 6] and others in 4(10%) cases.
Table 1
Nose foreign body in different age groups (n=171)
|
Age in years |
No of cases |
Percentage (%) |
|
0-5 |
123 |
71.9 |
|
6-10 |
35 |
20.4 |
|
11-20 |
0 |
0.0 |
|
21-40 |
0 |
0.0 |
|
41-70 |
10 |
5.8 |
|
>71 |
03 |
1.7 |
|
Total |
171 |
100.0 |
Table 2
Ear foreign body in different age groups (n=143)
|
Age in years |
No of cases |
Percentage (%) |
|
0-5 |
78 |
54.5 |
|
6-10 |
29 |
20.2 |
|
11-15 |
21 |
14.6 |
|
16-20 |
0 |
0.0 |
|
21-40 |
08 |
5.5 |
|
41-70 |
07 |
4.8 |
|
> 71 |
01 |
0.6 |
|
Total |
143 |
100.0 |
Table 3
Throat foreign body in different age groups (n=40)
|
Age in years |
No of cases |
Percentage (%) |
|
0-5 |
24 |
60.0 |
|
6-10 |
02 |
5.0 |
|
11-20 |
0 |
0.0 |
|
21-40 |
12 |
30.0 |
|
41-70 |
02 |
5.0 |
|
> 71 |
0 |
0.0 |
|
Total |
40 |
100.0 |
Table 4
Types of foreign body in nose (n=171)
Discussion
In our study nasal foreign bodies showed the highest incidence (48.3%) followed by ear (40.4%), and throat (11.3%) which was similar to findings of other study 7 although some studies have been shown aural foreign bodies were more common.1, 8 The most commonly affected age group were 0-10 years in present study and these observation were similar to other studies also.9, 10 Because of inefficient mastication with improper deglutition and exploratory behavior in form of putting objects in mouth and different body orifices as well as frequent crying and shouting during playing make them vulnerable to affected with the foreign bodies.11, 12 In present study observation revealed that in paediatric age group, seeds or nuts represented the commonest foreign bodies in nose (39.2%) and ear (2.7%) which was in accordance with the study by Barrettto RL et al.13 The populations which were affected most belongs to farmers due to availability of vegetative and grains seeds in their houses although Higo et al in their study have been found higher incidence of plastic made toys in paediatric population. 7 The observation in present study shown that cotton[28.6%] and matchstick [25.8%] were commonly encountered foreign bodies in adults along with the insects inside the ear were also frequently seen which was similar to findings of Antonelli PJ et al. 14 For adults cases in our study the percentage of throat foreign bodies were exceeding the ear and nose foreign bodies. In our study in throat, fish bone (60%) and coin (30%) is the most common foreign bodies which was as per findings of study by Endican S et al. 8 Management of foreign body in term of removal were successfully done for majority of cases in outdoor basis with detailed history taking and thorough examination although in some cases general anaesthetic support was taken for removal of foreign bodies. In a prospective evaluation based study by Hon SK et al the possible complication related to presence of foreign bodies in either nose, ear and throat will be minimized if the patients were referred earliest to higher centre. 6 For throat foreign bodies commonly found site of lodgment was tonsillar crept and cricopharynx in present study which was in accordance with other study. 15
Conclusion
In conclusion the presence of ENT foreign bodies were more common in children and the type and site of lodgment of foreign bodies were varies in different age groups. However early diagnosis and referral reduce complications related to these foreign bodies and help in appropriate management.
