Foreign body of a throat

Description:

Foreign bodys of a throat meet considerably less than foreign bodys of a trachea or bronchial tubes, and make, according to different authors, from 4 to 14% of number of all foreign bodys of upper respiratory tracts. The majority from got into a throat foreign bodys overcome its space and get stuck in the right primary bronchus which otkhozhdeniye corner from a trachea is much less, than the left primary bronchus. In a throat mainly sharp-pointed foreign bodys (fish and thin chicken bones, needles, dentures, walnut shell fragments, metal objects) are late. Quite often in a throat bloodsuckers who get into it at water drink from natural reservoirs — habitals of these annlides are fixed. The most often foreign bodys of a throat are observed at children at the age of 5 — 7 years. Quite often foreign bodys of respiratory tracts are observed at old men with the reflexes weakened protective pharyngeal and switching and at mentally sick persons.

Symptoms of the Foreign body of a throat:

The foreign bodys of the considerable sizes (a piece of meat, adenoid growths, an aspirirovanny tampon, etc.) which are characterized by a soft elastic consistence at a reflex spasm of a throat, as a rule, completely block a throat, without leaving cracks and the courses for implementation at least of the minimum breath, very often lead to death from asphyxia. If obstruction of a throat not full, then a foreign body provokes powerful tools of protection which not all play a positive role, for example a protective spasm while severe paroxysmal cough, nausea and vomiting promote pushing out foreign bodys both from a laryngopharynx, and from a throat. Very quickly, during ten seconds, there is cyanosis of the person on which expression of an extraordinary fright is imprinted. The victim begins to rush about, his movements become chaotic, the hoarse voice and the convulsive respiratory movements are vain. Such state can proceed 2 — 3 min. and if foreign bodys it is not cast out or any way is not removed, then consciousness quickly abandons the patient, it falls into coma and a condition of clinical death. In time not recovered breath (within 7 — 9 min.) leads to death from a stop of cordial and respiratory activity. If it is possible to recover cordial and respiratory activity through the specified period or slightly earlier, then there is a threat of partial or full switching off of the cortical centers at which the syndrome of a decortication of various depth therefore the patient passes to a vegetative way of life develops. If foreign bodys puts between true voice folds and interferes them with a smykaniye, and there is a space for the minimum passing of air, then there come the sudden aphonia and this or that degree диспноэ. The throat perforation can lead foreign bodys to emphysema, especially at expiratory disturbance of breath when above the obstacle to an air exhalation arises perforation.

Diagnosis foreign bodys of a throat in acute cases does not cause difficulties; it is based on suddenness, external signs of sudden reflex irritation of sensitive receptors of a throat, paroxysmal cough, a dysphonia or an aphonia, диспноэ or an apnoea. Chronic cases at the delayed addresses of victims to the doctor are more difficultly diagnosed. Most often such cases are observed at not obstructive foreign bodys of a throat when breath remains satisfactory, and put foreign bodys various local complications begin to accompany (the infected decubitus, hypostasis, a perichondritis, etc.)

Reasons of the Foreign body of a throat:

Foreign bodys of a throat can come from an oral cavity during food, from a nasal cavity and a nasopharynx where they get to time of childish sports and from where are aspirated in a throat, and also retrogradno at cough from a trachea and bronchial tubes or during vomiting from a stomach and a gullet. the foreign bodys of a throat relating to iatrogenic can arise during an adenotomy and a tonsillotomy (aspiration of remote limfoadenoidny fabric, a fragment of a surgical instrument). The most frequent mechanism foreign bodys of a throat is the sudden aspiration foreign bodys arising during food at laughter, sneezing, a conversation, unexpected blow in a nape. Aspiration foreign bodys can happen during sleep, in an ebrietas or drowsiness, at derivation of attention or a fright. Foreign bodys of a throat can be observed at some bulbar syndromes at which sensitivity of a throat and throat is broken, at neuritis of sensory nerves of a throat, etc.

Treatment of the Foreign body of a throat:

Treatment of foreign bodys of a throat, even small, pose hazard to life as feature of tissues of throat and to its reflexogenic zones are bystry developing of obstruktiruyushchy hypostasis and almost instant reflex laryngospasm. Therefore in all cases not obstructive foreign bodys of a throat the immediate call of "ambulance" or delivery of the victim improvised transport in the nearest medical institution in which there is an endoscopist or the LOR-specialist is necessary. Foreign bodys make removal only under control of sight in the earliest terms to prevent developing of the hypostasis which is sharply complicating the procedure of extraction and fraught in some cases with traumatic complications (a rupture of a mucous membrane, a predoor or voice fold, an incomplete dislocation of a perstnecherpalovidny cartilage, etc.). Only in case of developing of asphyxia at localization foreign bodys in a laryngopharynx before arrival of the medic the attempt of his removal by means of a finger in which, however, pushing through foreign bodys in deeper departments of a throat is possible is admissible. Some authors foreign bodys and its ejections recommend to make blows for dislocation by a palm edge by an occipital part of a neck. Possibly, the mechanism of such removal consists in transmission of energy of a shock wave to internal tissues of a neck in the direction foreign bodys and its pro-pulsations in a stomatopharynx.

Asphyxia can be prevented by means of tracheotomy or an interkrikotireoidalny laryngotomy as a result of which saving breath is recovered "on a scalpel tip". Removal put foreign bodys is made after tracheotomy, at the same time the tracheostoma is used for an intubation anesthesia. Position of the victim and the procedure of a direct laringoskopiya are described above. At small children foreign bodys make a direct laringoskopiya and removal without local anesthesia, a reflex apnoea, fraught at them, and under premedication the phenobarbital operating as anticonvulsant substance, and Chlorali hydras.

The foreign bodys which put in throat ventricles, pear-shaped sine and subdepository space are the most difficult for removal. Such foreign bodys make removal after tracheotomy, at the same time the tracheotomic opening can serve for pushing through foreign bodys up or its removals through a tracheostoma. During removal foreign bodys of a throat there can be a reflex apnoea to which the medical staff has to be ready, having at the order means, necessary for recovery of respiratory function (oxygen, Carbogenum, respiratory analeptics — lobeline, Cytitonum, etc.).

At old foreign bodys of a throat the tireogomiya with preliminary tracheotomy, especially in the presence of granulations, decubituses and ulcers or the phenomena of a hondroperikhondrit, perforation of a throat is shown. This surgical intervention pursues two aims — removal foreign bodys and the sanifying manipulations for elimination of secondary complications.

In all cases foreign bodys of a throat prescription of antibiotics of a broad spectrum of activity for prevention of secondary complications, and also sedative, soothing and in certain cases tranquilizing means is shown.

The forecast is serious, especially at small children who are more located to heavy asfiksiya and a bystry lethal outcome. In general, the forecast depends on extent of obstruction of a throat and timeliness of rendering efficient medical care.