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Full text of "Diseases Of The Nose Throat And Ear"

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An infinite variety of foreign bodies may be inhaled or swallowed. While many
foreign-body accidents are preventable it is surprising that they are not more
common when one considers how often pins, tacks or hair-grips are held in the
mouth while the mind and hands are otherwise occupied. There is a natural
tendency among children to cany small objects in the mouth, and they
constantly experiment with the feel of different objects with their teeth. It may
be that the protective reflex action is less well developed in children, so that
such objects are more easily inhaled or swallowed.

A report that a foreign body has been 'swallowed* must not be taken
literally, because laymen use this term to mean that it has left the mouth. It
may have entered the oesophagus either to be arrested there or to pass into the
stomach, or it may have been inhaled to lie in the trachea or bronchi. It is of
the utmost importance that an accurate history of the incident be taken to
determine whether or not there has been any spasm of coughing and
dyspnoea, which would suggest inhalation. The absence of such a history
usually implies that the object has entered the oesophagus although it is
conceivable that before it did so it stimulated a reflex spasm in the larynx.


A foreign body in the larynx is readily diagnosed because the patient coughs
and chokes, and is unable to speak. He points to the front of the larynx as the
seat of the pain. A history of the accident is usually obtainable. There is
generally no time to obtain a radiograph (Fig. 108), as a foreign body in the
larynx calls for urgent removal. This is rarely possible at indirect laryngo-
scopy, and direct laryngoscopy gives an easier mode of access. When there is
obstruction to breathing with cyanosis, and when the direct method is
impossible at the moment, the circumstances call for an immediate tracheo-
stomy, followed later by removal of the foreign body from the larynx when
the danger to life has passed. In less urgent cases if there are an experienced
anaesthetist and an experienced bronchoscopist available immediate removal
may be undertaken, and under the relaxed conditions of anaesthesia the
intruder is easily removed.


Foreign bodies only enter the trachea and bronchi after passing through the
larynx. In the conscious patient their entry is resisted by the spasmodic
closure of the vestibular and vocal folds with the production of a spluttering
spasmodic coughing, and of dyspnoea with stridor. If this protective reflex has