If it is a Sunday, our endoscopy department would be working full force with many patients visiting us with foreign bodies. The most common culprit is the fishbone, throwing its one last punch before being assimilated by the gastric juices.
Fishbone and any other foreign body if stuck in the throat can most of the times be pushed away with a gulp of water or with a large soft bolus of rice. If this manoeuvre doesn’t relieve you of your pain or discomfort after trying a few times, it means that the foreign body has lodged deep in your throat. It is imperative at this point not to meddle your throat with your fingers or induce gawking or vomiting as this would only worsen your discomfort. It means the time has come for you to visit your ENT surgeon.
Most of the foreign bodies we have seen till now either lodge into the tonsils, back of the tongue, side walls of the throat and few times deep in the throat at the entry of the food pipe.
On visiting your ENT surgeon, He will thoroughly examine your throat under headlight for any visible foreign bodies.
Any foreign bodies lodged in the tonsil can be visualised and removed under headlight illumination.
The foreign bodies in the back of the tongue, sidewalls of the throat and in the deeper parts of the throat cannot be visualised with headlight when he will suggest a Video laryngoscopy.
Video laryngoscopy (VLS) is a very well tolerated outpatient procedure in which a small amount of anaesthetic is sprayed onto your palate, back of tongue and back of the throat to numb them. An endoscope is advanced through your mouth to visualise the back of tongue, voice box and entry of food pipe. Once the foreign body is visualised, it is removed with the help of instrumentation.
In very few cases your doctor may not be able to remove the foreign body under VLS guidance, when he may suggest its removal under general anaesthesia.
On VLS, Sometimes no foreign body is visualised, but the patient still feels the discomfort, pain. In most of these cases, it could either be because the foreign body caused abrasions on the way to the stomach or because of the finger manipulation done by the patient before visiting the doctor. In very few of these cases, the foreign body is very deeply seated, not visible to naked eye, when radiological investigations will be ordered or “wait and watch policy” is undertaken. A two day period is given when the patient is asked to carefully watch for increasing pain, the start of fever, swallowing or breathing problems, and if they occur, he is asked to visit the doctor immediately.
This is a video of one of my patients who had fish bone lodged deeply into the entry region of the food pipe (aka cricopharynx). You can see me and my colleague Dr Laxminath removing it. At our hospital, we have two doctors working in tandem to remove such deeply lodged foreign bodies. While one doctor visualises the throat with the endoscope, another doctor uses his two hands on instrumentation to precisely remove the foreign body.
This is a box with all the removed foreign bodies stored from the past year (sometimes the patients insist on taking the removed foreign body with them) stored at a top secret place in our hospital. Maybe next time you visit us, you can ask us to have a look at it.