Children, do not swallow coins and balls!

Interview with a specialist in the field of diseases of the ear, nose and throat, professor New Y Eye and Ear Infirmary

IGOREM BRANOVAN

The title of the interview with Professor Igor Branovanov emphasizes that the majority of those who swallow different foreign objects are children. But not only. In life, this happens with adults. The difference lies mainly in the fact that in adults it happens by chance, and children often do it intentionally, out of curiosity. But the consequences are equally unpleasant for those and for others. Apparently, if my interlocutor had time and desire, he could create a whole “museum” of objects that were swallowed up and stuck in his ears and nose. Their size ranges from small coins to ... knives and forks.

— How quickly find out what happened to the victim? What help is the most effective and safe?

The otolaryngologist, professor of the Institute of the ear, throat and nose in Manhattan Igor Branovan tells about all these and other issues related to the provision of medical care when foreign bodies enter the ears, nose and pharynx of children and adults.

IGOR BRANOVAN: It is difficult to find a person who would not have to be in a similar situation in his life. And then it is repeated with children, grandchildren, great-grandchildren. This happens more often with children of 3 - 7 years, that is, at the age when they begin to be more actively interested in the outside world. And the outside world for them lies in the objects around them, which for some reason they try to put in their mouths, nose, ears, and so on. What is more dangerous in their actions, what is less dangerous? First of all, it should be noted that in most cases it is difficult for parents to establish the moment when this “action” occurred. This usually happens when a small child is left unattended for a while.

What symptoms can be used to judge the appearance of a foreign body in the body?

If any small object gets (was shoved) into the ear, it causes injury to the ear canal, which leads to the development of otitis externa. Its signs are redness (hyperemia), swelling of the ear, accompanied by severe pain, the appearance of infection with purulent discharge from the ear. Fortunately, usually the eardrum remains intact, since the child rarely “manages” to insert a foreign object so deeply. The sad exception is pins and pencils. Therefore, it is very important for adults not to use cotton swabs when regularly cleaning a child’s ears, for example, from earwax, as the child may then try to imitate adults. In most cases, parents are unable to look into the child's ear due to the lack of appropriate tools and experience. Therefore, in such cases, the intervention of an otolaryngologist and pediatrician is required. Only in cases where the ear canal is closed by swelling, the pediatrician fails to do this. In such cases, urgent intervention by an otolaryngologist is necessary to remove the foreign body.

Such foreign objects as miniature electric batteries are especially dangerous. Their danger lies not only in the possibility of mechanical injury, but mainly in the fact that within an hour after the child’s body gets in, the acid in them begins to be absorbed through the damaged skin into the bloodstream, causing great harm to the body. There is a poisoning, the consequences of which can be very serious. There are even cases of death. Therefore, if adults have even the slightest suspicion that a child has stuck a battery somewhere (in the ear or in the nose) a battery, you must immediately take it to a specialist - otolaryngologist or to the emergency room of the hospital. It is necessary to remove such a foreign body immediately, sometimes even anesthesia has to be used. Fortunately, in most cases the situation is not so dramatic and we manage to carefully remove the foreign object, wherever it is (in the ear canal, nose, throat) using special tweezers under the control of the microscope. If we are talking about a foreign object in the ear, we recommend dropping drops within a week after removal.

A somewhat different position in relation to foreign objects that fell into the nose. The nose is the beginning of the airways. Its continuation is the upper and lower respiratory tract, from which air enters directly into the human lungs. Therefore, it is possible that a foreign body stuck in the nose, in the same way will fall into the trachea, and then into the large bronchi and lungs. This can block the access of air to the lungs within minutes. Therefore, if a foreign body in the auditory canal requires intervention in emergency room conditions only in rare cases, the foreign body in the nose dictates the need for immediate intervention.

— What can you say about foreign objects in adults?

— More often this happens to older people and usually concerns large pieces of food or fish bones that are swallowed and stuck in the throat or upper part of the esophagus. This is due to the fact that in old age people lose some of their teeth, and with the help of false jaws it is not always possible to chew food well enough. Because of this, poorly chewed pieces of food can enter the esophagus and get stuck there. When it comes to bones, we see a pattern—chicken bones tend to get stuck in the pharynx and upper esophagus. Fish bones often get stuck higher - in the back of the tongue; it is much easier for otolaryngologists to remove them, since they are more accessible during examination. However, the main complaint of victims in both cases is the same - pain in the throat when swallowing.

If, when trying to swallow food, it does not pass through the esophagus, it means that the esophagus is completely clogged and immediate removal of foreign body (food pieces) is required. Often, after a person chokes or swallows a bone, he continues to feel pain when swallowing, even in those cases when he safely swallowed it. This is due to the fact that there appeared a scratch on the mucous membrane of the pharynx, which for some time felt like a stuck bone. We have similar sensations when a speck enters the eye.

But in order to be convinced that this is only a reaction to the scratch, and not the remaining bone, we must see the damaged place, as they say, “with our own eyes”, and it is not easy to do even the otolaryngologist or gastroenterologist, because into the esophagus not so easy to “peek into.” Local anesthesia is not enough, and giving anesthesia in all such cases is also undesirable. Where is the way out? On the basis of sufficient experience, I recommend the following tactics in such cases: if the victim continues to eat and breathe normally during the first days after the accident, although he complains about scratching his throat and if the battles over this period gradually subside, then no intervention is required.

But if a person is hard to swallow, food does not pass and, which is especially important if the body temperature rises, an immediate examination of the esophagus is required under anesthesia. When a foreign object is detected, its removal is necessary. An increase in temperature is a particularly alarming sign because the esophagus borders the mediastinum, the part of the chest located between the lungs. Here, in particular, the heart and large nerve trunks are located. An increase in temperature may indicate the entry of infected saliva or food into the mediastinal tissue through the perforated wall of the esophagus. Without emergency intervention from specialists, this can quickly lead to sepsis and death. In these cases, the patient should be immediately taken to the hospital. Here, in the operating room under general anesthesia, an endoscopic examination of the esophagus is performed. This procedure can be performed by gastroenterologists, but esophageal catheterization and subsequent endoscopy are best performed by experienced otolaryngologists. The fact is that gastroenterologists usually use soft probes during endoscopy of the esophagus, which in such cases provide less information. In addition, if, after examining the walls of the esophagus, it is determined that there is a perforation, immediate surgical intervention will be required. And it must be carried out by a surgeon - an otolaryngologist. In the USA, unlike Russia and other CIS countries, an otolaryngologist, along with medicinal treatment of diseases of the ear, nose and throat, also carries out surgical treatment if indicated. The scope of activity of otolaryngologists in the United States also includes surgical treatment of thyroid diseases.

Fortunately, in children, foreign objects in the esophagus get stuck less often. Most often this happens with coins that small children like to swallow for some reason. In order to make an accurate diagnosis in such cases, an x-ray examination is necessary. If it is determined that the child has swallowed a coin and it is in the esophagus, its removal is required by surgery. Removal is performed under general anesthesia. Usually we manage to carry out such a manipulation quickly, without any danger to the victim. In conclusion, I want to once again return to the question of numerous cases involving foreign objects that are swallowed and shoved by children in the ears, nose, mouth, etc. In some cases, such situations end in a “slight fright”. However, in a number of cases, severe complications arise that require emergency surgical intervention, which is not always possible to carry out if the child is far away from the hospital, if not immediately others understood what had happened. In such cases, the sad consequences of what happened are not excluded. Therefore, as a doctor, who often has to deal with such situations, I would like to remind parents of the importance of proper parenting. This applies equally to general issues of behavior, as well as a number of private issues, including careful handling of various foreign objects of interest.