• Food bolus and oesophageal foreign body: a summary of the evidence and proposed management process

      Stubington, TJ (2021-01)
      Purpose: Food bolus and oesophageal foreign bodies are a common presentation that may be managed by otolaryngologists, gastroenterologists, acute medicine physicians and accident and emergency. The condition is highly variable with presentations ranging from well patients whose obstruction spontaneously passes to peri-arrest with severe aspiration or impending airway compromise. Management of this condition is heterogeneous and often depends on the specialty the patient is originally admitted under. There exist European and American guidelines from the perspective of gastroenterology, but there are no UK-based guidelines and limited consideration of the role of the otolaryngologists and rigid oesophagoscopy. Methods: An extensive literature search was carried out to generate conclusions on key management questions for food bolus and oesophageal foreign bodies. This was then summarised into both a written summary of the evidence and a graphical decision tree. Results: This paper is a review article and presents conclusions regarding management options for food bolus and oesophageal foreign bodies. Conclusion: This article considers the current evidence surrounding investigation and management of oesophageal food bolus and foreign body. It draws conclusions regarding presentation, investigation and subsequent operative treatment. As part of this process, we propose a graphical decision tree to assist in management decisions.
    • Retrieval of inhaled foreign bodies in laryngectomised patients: Novel technique using a flexible nasendoscope under local anaesthetic.

      Whittaker, Joshua; Mallick, Sameer (2019-02)
      Laryngectomised patients are at inherent risk of inhalation of foreign bodies, which can be an emergency airway situation. A retrofitted flexible nasendoscope can be a safe, effective and a more familiar instrument for otolaryngologists, especially when the procedure needs to be undertaken out of hours. Conducting the procedure with nebulised local anaesthetic and sedation is favourable in patients with high burden of comorbid disease and makes the procedure well tolerated.
    • Unusual 'feathery' cause of a parapharyngeal abscess in an infant.

      Cho, Wai Sum; Nistor, Mihaela; Ubayasiri, Kishan; Johnston, Mark (2018-01)
      A 7-month-old boy presented to the emergency department with reduced oral intake, neck swelling and fever. Clinical examination revealed a 3 cm left parotid and left level I neck swelling with left medialised tonsil but no trismus. Computed imaging confirmed the presence of an abscess in the peritonsillar area with extension into the parapharyngeal space and deep lobe of the parotid gland. The abscess was incised and drained transorally. Following drainage of the abscess, a small 3 mm suspicious foreign body was seen. After extraction, this was revealed to be a 60 mm feather. We would like to highlight this unusual case in an infant and to ensure that foreign body is considered as aetiology. There are only a handful of cases in the literature involving feathers causing neck abscesses and, to our knowledge, this is the first case where the patient presented with a pharyngeal abscess, which was drained transorally.