Foreign bodies of the larynx are called a variety of foreign objects that accidentally ended up in the laryngeal passage. It can be both small household items, and parts of food, medical instruments, living organisms. In this case, varying severity of respiratory failure, complete aphonia or hoarseness of the voice, painful sensations, paroxysmal cough develop.
Diagnosis of foreign bodies in the larynx is based on typical signs of a clinical picture, laryngoscopy, x-ray data, microlaryngoscopy. Therapeutic tactics is to immediately remove a foreign body. The technique used will depend on the location and size of the alien object. This may be a laryngotomy, tracheotomy, laryngoscopy. Such manipulations are carried out in the centers of otolaryngology.
Children
Otolaryngological practice indicates that the ingress of foreign bodies into the larynx is a rather rare case. Some sources report that such problems occupy up to 14% of foreign objects entering the upper respiratory system. Most often, cases are recorded in children 3-7 years old.
They often complain that a bone stuck from a fish in their throats, for example.
Aged people
The next most common group of patients is considered to be elderly patients who have a decrease in the protective pharyngeal reflex that impedes the movement of a foreign object from the pharynx to the larynx. Often recorded cases of the ingestion of various objects in the larynx in patients suffering from various mental illnesses.
Description of foreign bodies
Most often, foreign bodies of the larynx have a rough surface, uneven edges, large size, so that their passage into the trachea is difficult, and they linger directly above the glottis. To the greatest extent this is facilitated by reflex contractions of the muscles that narrow the larynx. Most often, foreign objects are found in the interchaloid space. In this case, one edge of the object is able to abut against the posterior laryngeal wall, and the other is located in the laryngeal ventricle. In some cases, foreign bodies are localized in the sagittal plane, while getting stuck in the vocal folds. One of their edges is fixed by the back wall of the under-folding space or the arytenoid region, the other by the front commissure.
Pathogenesis of foreign objects of the larynx
The main mechanism for the ingress of foreign bodies into the larynx is considered to be its ingestion with a stream of air on a deep breath. Food particles can be aspirated if a person talks, laughs, sneezes, and hurries while eating. Sudden aspiration of a foreign object at a deep entrance can occur during crying, falling, with fear, if a person is intoxicated.
In this case, an object that can be held by the lips or in the oral cavity can become a foreign body.
Such objects can be nuts, seeds, seeds, toys, cogs, needles, pins, buttons. Many people wonder if a bone is stuck in the throat, what to do. We will talk about this below. In some cases, dental prostheses (for example, cermet, metal, temporary crowns) that migrate to the patient's larynx when he sleeps can become foreign bodies. In addition, insects or leeches, which enter the mouth if a person drinks water from open reservoirs, can become a foreign object.
Reflex spasm
Most often, the ingress of foreign bodies into the mucous membranes of the pharynx is accompanied by a reflex spasm of the pharyngeal and laryngeal muscles, which represent a kind of barrier and prevent the penetration of a foreign object into the larynx. Accordingly, the penetration of foreign bodies may be due to the weakness of this reflex. Such a violation is often observed in people of advanced age and having neurological disorders such as cerebral atherosclerosis, amyotrophic lateral sclerosis, poliomyelitis, syringomyelia, myasthenia gravis, multiple sclerosis, ischemic stroke, hemorrhagic stroke, tumor formations with bulbar and pseudo-bulbar, neuritis of the nerves in the larynx.
It is not excluded that foreign bodies can enter the larynx retrograde by coughing from the trachea and bronchi, and vomiting from the stomach.
Quite rarely, but still there are alien bodies of the larynx, which are iatrogenic in origin. These include parts of removed tissues, medical instruments that can enter the larynx during various dental procedures (surgical treatment of snoring, removal of tumor in the larynx and pharynx, correction of atresia of the choanas, adenotomy, tonsillectomy.
Symptoms of foreign bodies in the larynx
Clinically, the presence of foreign objects in the larynx can manifest itself in different ways, depending on what size, shape and texture the object has. If a foreign body of a small size enters the larynx, the patient develops a convulsive cough, difficulty breathing, and cyanosis of the skin of the face develops. Also, the penetration of a foreign body into the larynx may be accompanied by reflex vomiting. However, the exit of an object with masses of vomiting or coughing up occurs in very rare cases. When a foreign object remains in the larynx, the patient's voice wheezes, he begins to experience soreness in the throat. In some cases, pain is accompanied only by coughing or speech, in other cases it has a constant character, and when talking intensifies. Over time, coughing attacks occur more often. If a foreign body is located between the vocal cords, it can prevent them from closing, as a result of which aphonia is observed. Sometimes blood may appear in the larynx.
When small foreign bodies get in the first time, respiratory disorders do not develop, only a periodic cough and slight hoarseness appear. Then, in the area of their localization, an inflammatory process appears, which provokes progressive edema and narrowing of the laryngeal lumen. The result is difficulty breathing. When a secondary infection joins, the temperature begins to rise, mucopurulent sputum is secreted.
When do you need to act quickly?
When something interferes in the larynx and the unwanted object has an elastic consistency and considerable size (insufficiently chewed meat pieces, cotton swabs, removed adenoids), the patient has an immediate obstruction of the laryngeal lumen, as a result of which oxygen is blocked. In a patient, the skin of the face becomes cyatonic in a matter of seconds, there is a significant fright on it. The patient begins to wheeze, rush about, make convulsive attempts to inhale, which are unsuccessful due to obstruction. After a couple of minutes, if there is no help, a coma begins to develop. A foreign body in this case should be removed by tracheostomy no later than 7 minutes. Otherwise, the patient stops breathing and heart activity, which causes death. If breathing and cardiac activity were restored only a few minutes after the onset of asphyxiation, do not exclude the possibility of disabling the cortical centers of the brain against oxygen starvation.
Complications resulting from foreign bodies
Quite often, foreign objects in the larynx provoke the development of inflammatory processes at their location. The severity of inflammation depends on the infection of a foreign object, its type, duration of stay in the larynx. If their stay is long, then the formation of contact ulcerative lesions, granulomas, bedsores, the attachment of a secondary infection is possible. If the foreign body is sharp, the onset of perforation and its migration to adjacent anatomical structures are not ruled out. As a result of the perforation, mediastinal emphysema can develop, it also contributes to the penetration of secondary infection and the development of sepsis, thrombosis in the jugular vein, mediastinitis, perichondritis, pharyngeal abscess, perylaringeal abscess.
If the foreign body entering the larynx is large, concomitant swelling of the mucous membrane is present and muscle spasm develops in the larynx, complete closure of the laryngeal lumen and, as a result, asphyxiation, which causes the patient's death, can occur. To prevent this, you can call a doctor at home. This can be done now even at night. The service "ENT around the clock" is very popular.
Diagnosis of foreign bodies in the larynx
If the entry of a foreign object into the larynx is accompanied by obstructive syndrome, then the diagnosis is based on clinical manifestations and typical sudden symptoms. In case of minor respiratory disorders that do not require urgent care, a specialist from the center of otolaryngology can prescribe a laryngoscopy to clarify the diagnosis. When examining children, a direct type of laryngoscopy is used, for adults, an indirect type.
If an unwanted object entering the larynx does not cause respiratory distress, the patient should seek the help of an otolaryngologist as soon as possible. For example, when a bone stuck from a fish in the throat. Indeed, within a few days, inflammation and swelling of the mucous membrane in the larynx may develop, which will interfere with the normal visualization of the object. In such cases, for diagnosis, laryngeal endoscopy is used, which allows you to consider more difficult to access areas. If the case is complicated, then a specialist can use a special metal detector to search for metal objects.
In some cases, you can call the ENT to your home.
An X-ray examination makes it possible to detect only those foreign bodies that are radiopaque. In addition, radiology allows you to detect mediastinitis, abscess, emphysema, if any. An x-ray of the esophagus using a contrast medium allows you to differentiate foreign objects of the larynx from unwanted bodies in the esophagus. It is also necessary to differentiate objects in the larynx from papillomatosis of the larynx, tuberculosis, syphilis, diphtheria, benign tumor formations in the larynx, laryngospasm, lining laryngitis, whooping cough.
Removal of foreign objects from the larynx
So, the bone is stuck in the throat, what should I do?
Removal of unwanted bodies from the larynx should be done immediately. If the patient develops asphyxia, he is shown a tracheostomy. Then the patient is placed under stationary observation and foreign is removed through a tracheostomy using intubation anesthesia.
Foreign bodies that do not cause obstruction should also be removed urgently, as otherwise inflammation and edema may develop, greatly complicating the removal of the object. For adult patients, foreign body removal is performed under local anesthesia by laryngoscopy. The procedure should be carried out exclusively in stationary conditions. If a foreign body enters the larynx in a child, phenobarbital is previously administered to it, since the use of a local anesthetic can provoke respiratory depression.
Now there is such a service as “ENT home”. About it further.
What's the hardest thing to remove?
The most difficult thing is to remove an object that has penetrated into the back space, ventricles or pear-shaped sinuses. If removal by natural means is not possible, specialists perform surgical removal. Most often, the intervention is a tracheostomy. Tracheostomy in such cases can be used not only to remove the object, but also to push it up. If there is a need for wider access, laryngotomy is indicated. Surgery to remove an unwanted object from the larynx can cause complications such as cicatricial stenosis.
Foreign bodies from the larynx should be removed against the background of the use of analgesic, anti-inflammatory and sedative therapy. In order to prevent complications of an infectious nature, the use of systemic antibiotic therapy is indicated.
First aid in contact with foreign bodies
This is the most severe type of injury that requires urgent care. Particles of food can enter the respiratory system. Children often take small objects into their mouths that, during laughter, crying, and talking, may fall into the larynx. Usually this happens suddenly, accompanied by a strong cough. With a complete blockage, a person begins to choke and turn blue. Assistance should be provided immediately.
If a child chokes and suffocates, what should I do?
If a foreign object enters the larynx, the baby should:
- Call an ambulance - this is better for a third party, you can not lose time. In large cities there is such a service as "ENT around the clock."
- It is necessary to give the victim a cough - an object that partially blocked the air access to the lungs can come out by itself.
- If a person suffocates, you need to hit the palm of your hand between the shoulder blades several times.
- The baby is usually lifted by the legs and shaken several times.
- If this does not help, then Heimlich’s reception is performed . It is necessary to stand behind the victim, clasp his hands on his stomach in the upper part; then, with a sharp movement, the fist of the right hand is directed inward and upward, thereby increasing pressure in the chest cavity and in the lungs; sharp movements should be at least five; a stuck item should pop out.
What to do if a child chokes and suffocates, every parent should know. You should also be able to provide first aid to the injured baby. Such knowledge and skills can someday save his life.