Primary Care Otolaryngology

Chapter 4

Foreign Bodies Foreign bodies can present as airway emergencies. Usually, however, by the time the patient gets to the emergency room, the foreign body in the airway has been expelled (often by the Heimlich maneuver ), or else the

patient is no longer able to be resusci- tated. Foreign bodies in the pharynx or laryngeal inlet can often be extracted by Magill forceps after laryngeal exposure with a standard laryngoscope. The patient will usually vomit, so suction is mandatory. Bronchial foreign bodies will require operative bronchoscopy for removal. Occasionally, a tracheotomy will be required, such as for a patient who has aspirated a partial denture with imbedded hooks. Children often aspi- rate peanuts, small toys, etc., into their bronchi. Occasionally these patients present as airway emergencies, although they more typically present with unexplained cough or pneumo- nia . Chevalier Jackson, the famous bronchoscopist , has noted, “All that wheezes is not asthma.” In other words, always remember to think of foreign body aspiration when a pedi-

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Figure 4.3. A coin is seen here trapped in the patient’s esophagus.

atric patient presents with unexplained cough or pneumonia. If a ball- valve obstruction results, hyperinflation of the obstructed lobe or seg- ment can occur. This is easier to visualize on inspiration-expiration films . Mucormycosis This is a fungal infection of the sinonasal cavity that occurs in immuno- compromised hosts. Typically it appears in patients receiving bone mar- row transplantation or chemotherapy. It is a devastating disease, with a significant associated mortality. Mucor is a ubiquitous fungus that can become invasive in susceptible patients, classically those with diabetes with poor glucose regulation who became acidotic . If there is any other system failure (e.g., renal failure ), mortality goes up significantly. The

Primary Care Otolaryngology