Foreign bodies of the larynx are 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. At the same time, respiratory disorders of varying severity develop, complete aphonia or hoarseness of the voice, pain, paroxysmal cough.
Diagnosis of foreign bodies in the larynx is based on typical signs of the clinical picture, laryngoscopy, x-ray data, microlaryngoscopy. The therapeutic tactic is the immediate removal of the foreign body. The technique used will depend on the location and size of the foreign object. It can be 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 sourcesreport that such problems account for 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 about a fish bone stuck in their throat, for example.
Elderly people
The next most common group of patients is considered to be elderly patients who have a decrease in the protective pharyngeal reflex that prevents the advancement of a foreign object from the pharynx into the larynx. Cases of various objects getting into the larynx in patients suffering from various mental illnesses are often recorded.
Description of foreign bodies
Most often, foreign bodies of the larynx have a rough surface, uneven edges, large size, due to which 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 interarytenoid space. In this case, one edge of the object is able to rest against the posterior laryngeal wall, and the other - to be 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 posterior wall of the subglottic space or the arytenoid region, the other by the anterior commissure.
Pathogenesis of foreign objects of the larynx
The main mechanism of entry of foreign bodies into the larynx is considered to begetting it along with a stream of air on a deep breath. Food particles can be aspirated if a person talks, laughs, sneezes, hurries while eating. Sudden aspiration of a foreign object at a deep entrance can occur during crying, falling, when frightened, if a person is intoxicated.
In this case, an object that is held by the lips or is in the oral cavity at this time can become a foreign body.
Such items can be nuts, seeds, bones, toys, screws, needles, pins, buttons. Many are wondering if the bone is stuck in the throat, what to do. We will talk about this below. In some cases, foreign bodies can be poorly fitted dental prostheses (for example, ceramic-metal, metal, temporary crowns) that migrate into the patient's larynx when he sleeps. In addition, inhaled insects or leeches that 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 on 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 who are elderly and have neurological disorders such as cerebral atherosclerosis, amyotrophic lateralsclerosis, stem poliomyelitis, syringomyelia, myasthenia gravis, multiple sclerosis, ischemic stroke, hemorrhagic stroke, tumor formations with bulbar and pseudobulbar syndrome, neuritis of the nerves in the larynx.
It is not excluded that foreign bodies get into the larynx in a retrograde way when coughing from the trachea and bronchi, with vomiting from the stomach.
Quite rarely, but still there are foreign bodies of the larynx that have an iatrogenic origin. These include parts of tissues to be removed, medical instruments that can get into the larynx during various dental procedures (snoring surgery, removal of tumor formations in the larynx and pharynx, correction of choanal atresia, 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 the size, shape and consistency of the object. If a small foreign body enters the larynx, the patient develops a convulsive cough, breathing becomes difficult, 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 the object with masses of vomiting or its coughing up occurs in very rare cases. When a foreign object remains in the larynx, the patient's voice is hoarse, 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, andincreases during conversation. As time goes by, coughing fits become more frequent. If a foreign body is located between the vocal cords, it can prevent them from closing, resulting in aphonia. Sometimes there may be blood in the larynx.
When foreign bodies of small size enter, at first, respiratory disorders do not develop, only 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 in breathing. When a secondary infection joins, the temperature begins to rise, mucopurulent sputum is released.
When to act quickly?
When something interferes with the larynx and an undesirable object has an elastic consistency and a significant size (not chewed meat pieces well enough, cotton swabs, removed adenoids), the patient experiences immediate obstruction of the laryngeal lumen, as a result of which oxygen access is blocked. In a matter of seconds, the patient's facial skin becomes cyatonic in color, there is a significant fright on it. The patient begins to wheeze, thrash 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. The foreign body in this case should be removed by tracheostomy no later than 7 minutes later. Otherwise, the patientbreathing and heart activity stops, which causes death. If breathing and cardiac activity were restored only a few minutes after the onset of asphyxia, one should not exclude the possibility that the cortical centers of the brain would turn off due to 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, and the duration of stay in the larynx. If their stay is long, then the formation of contact ulcerative lesions, granulomas, bedsores, the addition of secondary infection is possible. If the foreign body is acute, the onset of perforation and its migration to adjacent anatomical structures is not excluded. As a result of the resulting perforation, mediastinal emphysema can develop, it also contributes to the penetration of a secondary infection and the development of sepsis, thrombosis in the jugular vein, mediastinitis, perichondritis, pharyngeal abscess, perilaryngeal abscess.
If a foreign body that has entered the larynx is large, there is concomitant swelling of the mucosa and a spasm of the muscles in the larynx develops, there may be a complete blockage of the laryngeal lumen and, as a result, asphyxia, which causes the death of the patient. To prevent this from happening, you can call a doctor at home. This can be done now even at night. The service "ENT around the clock" is in great demand.
Diagnosisforeign bodies in the larynx
If the ingress of a foreign object into the larynx is accompanied by an obstructive syndrome, then the diagnosis is based on clinical manifestations and typical sudden onset symptoms. For minor respiratory disorders that do not require urgent care, a specialist from the otolaryngology center may prescribe a laryngoscopy to clarify the diagnosis. When examining children, a direct type of laryngoscopy is used, adults - an indirect type.
If the entry of an unwanted object into the larynx does not cause respiratory problems, the patient should seek help from an otolaryngologist as soon as possible. For example, when a fish bone is stuck in the throat. Indeed, within a few days, inflammation and swelling of the mucous membrane in the larynx may develop, which will prevent the normal visualization of the object. In such cases, endoscopy of the larynx is used for diagnosis, which allows you to examine in more detail hard-to-reach 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 an ENT at home.
When X-ray examination, it becomes possible to detect only those foreign bodies that are radiopaque. In addition, radiology can detect mediastinitis, abscess, emphysema, if any. X-ray of the esophagus using a contrast agent allows you to differentiate foreign objects of the larynx from unwanted bodies inesophagus. 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, subglottic 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 without delay. If the patient develops asphyxia, he is shown a tracheostomy. Then the patient is placed under inpatient observation and the foreign body is removed through the tracheostomy using intubation anesthesia.
Foreign bodies that do not cause obstruction must also be removed urgently, otherwise inflammation and swelling may develop, making removal of the object much more difficult. For adult patients, the removal of a foreign body is performed under local anesthesia by laryngoscopy. The procedure should be carried out exclusively in stationary conditions. If a foreign body has entered the larynx of a child, he is first injected with phenobarbital, since the use of a local anesthetic can provoke respiratory depression.
Now there is such a service as "ENT at home". More on that later.
What is the hardest thing to remove?
The hardest thing to remove is an object that has invaded the subglottic space, the ventricles, or the pyriform sinuses. If natural removal is not possible, specialists perform surgical removal. OftenThe intervention is a tracheostomy. A 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, a laryngotomy is indicated. Surgery to remove an unwanted object from the larynx can cause a complication such as cicatricial stenosis.
Foreign bodies should be removed from the larynx 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 for foreign bodies
This is the most severe type of injury that requires urgent care. Food particles can enter the respiratory system. Children often take small objects into their mouths, which can get into the larynx during laughter, crying and talking. It usually happens suddenly, accompanied by a strong cough. With a complete blockage, a person begins to choke and turn blue. Help must be provided immediately.
If a child chokes and suffocates, what should I do?
When a foreign object enters the baby's larynx, you should:
- Calling an ambulance is a third party doing better, no time to waste. In large cities there is such a service as "ENT around the clock".
- You need to let the victim cough - an object that partially blocked the access of air to the lungs can come out by itself.
- If a personsuffocates, you need to hit the palm of your hand several times between the shoulder blades.
- The baby is usually picked up by the legs and shaken several times.
- If this does not help, then the Heimlich maneuver is performed. You need to stand behind the victim, wrap your arms around his stomach in the upper part; then, with a sharp movement, the fist of the right hand is directed deep and upward, thereby increasing the pressure in the chest cavity and in the lungs; there should be at least five sharp movements; the stuck object 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 may someday save his life.
