Foreign body of the oropharynx ICD 10. What to do if a foreign body gets into your nose: algorithm of actions, recommendations for parents

Foreign bodies of the pharynx, as a rule, come from food (fish bones, cereal husks, pieces of wood, etc.), less often fragments of dentures, pins, nails get stuck (from tailors, shoemakers). If there is insufficient chewing and hasty swallowing, large pieces of food can get stuck above the esophagus, block the entrance to the larynx and cause asphyxia. Conversation and laughter while eating contribute to the entry of foreign bodies. Most often, sharp foreign bodies get stuck in the area of the pharynx, tonsils and root of the tongue, less often in other parts of the pharynx.

Code according to the international classification of diseases ICD-10:

T17.2

Symptoms, course. A feeling of something foreign in the throat, pain and difficulty swallowing. With large foreign bodies, speech and breathing are impaired. With a long stay of a foreign body, an inflammatory process develops, sometimes with the formation of phlegmon.

Diagnostics

Diagnosis diagnosed based on examination of the pharynx, palpation (small, deeply embedded foreign bodies) and x-ray examination (metal objects). Patients often complain of a foreign body, and upon examination of the pharynx, only injuries from a swallowed object are visible. Scratches and abrasions of the mucous membrane can simulate the presence of a foreign body for a long time.

Treatment

Treatment. Foreign bodies are removed with cranked tweezers or forceps.

Diagnosis code according to ICD-10. T17.2

Foreign objects getting into the nose is one of the most common reasons for visiting pediatric otolaryngology. But even adults are not immune from such a diagnosis. While children can purposefully place foreign bodies into the nasal cavity, in adults this phenomenon is most often accidental.

About pathology

A foreign body (FB) in the nose can be placed purposefully or accidentally. Moreover, this condition often occurs completely asymptomatic at first.

Then, over time, signs of a foreign object in the nose develop. Despite this, most often the symptoms of this phenomenon are quite bright, due to which the ENT doctor, after examination, removes the foreign body from the cavity.

Naturally, this condition is most often observed in children. As a rule, during games they place small parts of toys, beads, coins, fruit pits in the nose.

In 80% of cases, trapped objects are located in the lower part of the nasal passage. It happens a little less often that one end of a foreign body is wedged into the lower part of the nasal concha, and the other into the nasal septum. If a foreign body is accidentally introduced, it can be located in any location.

Classification of foreign bodies in the nose

Foreign bodies are classified into:

Inorganic - beads, beads, pebbles, plastic, and so on;
Organic - leaves, seeds, peas, seeds, etc.;
Metal - coins, construction parts, nails, needles, and so on;
Live – midges, roundworms, leeches, larvae.

Depending on how objects appear on x-rays, they are divided into radiopaque and radiopaque. The latter include living foreign bodies.

Foreign body in the nose, what you need to know:

Causes

The reasons for foreign objects entering the nasal cavity are:

Targeted introduction;
Accidental inhalation;
Objects left behind after medical procedures (including the patient’s own tissue);
while eating (when a person choked);
Entry through vomit.

There are many reasons for this development of events. Only children, as well as people with mental disabilities, do this purposefully. But foreign objects do not appear randomly so often. It is not uncommon that with the help of protective reactions of a mechanism such as sneezing, it is possible to get rid of IT in the nose.

Symptoms

Symptoms are often confused by people with allergies, which in general, in a sense, is what it is. In essence, an irritant is the same foreign body that the body tries to remove in every possible way.

Therefore, when a foreign object gets into the nasal passages, many experienced the following symptoms:

Tearing.

Symptoms often go away within a short period of time. After this, the foreign object may not bother the patient. Only one-sided is present. Painful sensations make themselves felt less often and only when the object has sharp ends.

If a person does not see a doctor, chronic irritation and injury to the mucous membranes develops, after which an inflammatory reaction develops. It leads to the development of the usual symptoms - pain in the nose, mucopurulent secretion discharged from one half of the nose, swelling and difficulty in nasal breathing in general.

But in some cases, typical symptoms appear almost immediately after IT gets into the nose:

Irritation;
Sensation of a foreign object in the nose;
Pain in the affected half of the nose;
Pain can radiate to the eye, forehead, cheek, or throat.

If the internal tissues are significantly damaged, nosebleeds may develop. Painful sensations also lead to sleep disturbances, increased irritability, moodiness, tearfulness, and anxiety (especially in children).

Unlike other types of pathologies of the nasal passages and sinuses, the manifestations are one-sided. The danger of the condition is that when you try to inhale, the FB may move into the larynx or pharynx.

Some foreign objects may undergo changes, for example, peas, beans may increase in size due to increased humidity, and some, on the contrary, fall into pieces, soften and completely decompose. If IT retains its appearance, then it often becomes the core of a nasal stone, overgrown with salt crystals from nasal secretions.

If the object is present for a long time, tissue granulation often develops, which as a result hides the foreign object during examination, preventing a correct diagnosis.

First aid

If a person has inserted a foreign object into the nasal passage, it is necessary to examine it. If an object is found almost at the outer part, it is necessary to carry out first aid. If this is not possible or the object is embedded tightly and deeply and tends to disintegrate or split, then it is better to consult a doctor.

Surgical method for removing a foreign body in the nose:

Algorithm of actions

If you cannot see a doctor, you must:

It is necessary to instill a vasoconstrictor drug into the nasal passage in the form of drops (a spray can aggravate the situation, they will push IT further).
If the child cannot follow commands, you need to close the healthy nostril (pressing it against the septum), and then take a sharp breath into the mouth. This action can help push the object out of the nose.
If the child is older, you need to ask him to stop breathing through his nose and take a deep breath through his mouth. Next, pinch the healthy nostril with your finger and ask to exhale sharply through the nose. If at the same time the child feels that the object is moving, then repeat the action until the nasal passage is freed from the IT.
If the procedure was not successful, you can drop Kalanchoe into the child’s nose or let him breathe in ground pepper.

If these actions do not lead to success, you should immediately consult a doctor or call emergency help. The child should be reminded that he needs to breathe through his mouth. It is forbidden to give food or drink at the same time.

Foreign body in the nose

What not to do

Do not do this if you have IT in the nose:

Remove the item using your finger, cotton swab or tweezers;
Press on the nostril with IT;
Rinse your nose with water.

With such actions, a change in the location of the object or injury to the nasal tissue will be almost inevitable. In this case, there is a risk of developing a massive type. In this case, you need to call an ambulance.

It should also be understood that even if a foreign object is removed from the nasal passage, the symptoms will persist for some time. If the signs of IT do not subside within 24 hours, you need to contact an ENT doctor, as there is a risk of leaving any of its parts in the nasal cavity or severe tissue injury.

Method for removing a foreign body in the nose

Diagnostics and necessary studies

It is necessary to visit an otolaryngologist, who will examine the patient, as well as:

Will hold ;
Order an x-ray;
Probing with a metal probe;
Analysis of nasal secretions (bacteria culture);

Extraction Methods

Removal of a foreign object is carried out:

using a hook. Local anesthesia is performed, and in the case of small children, general anesthesia.
If endoscopy is unsuccessful, surgery is used.

Additionally, nasal rinsing, sinus rinsing and drainage, and treatment of complications can also be used only in an ENT doctor’s office.

Why is a foreign body in the nose dangerous?

First of all, a foreign body in the nasal sinus is dangerous precisely because of the increased risk of the object moving into the pharynx or larynx, which can lead to suffocation.

But keeping an object in the nasal passage for a long time leads to:

Ulceration of the mucous membrane;
Necrosis of the nasal concha;
Suppuration of the lacrimal sac;
Impaired functionality of the tear ducts;
Attachment of a secondary infection;
Purulent;
Osteomyelitis of the nasal bones;

The longer treatment is not carried out, the higher the risk of developing severe pathological conditions.

Parents should not:

Leaving children unattended;
Giving toys that are not appropriate for age, especially small parts of construction toys often end up in the nose;
Give berries or fruits with seeds that the child can put in his nose or choke on;
Remove the fallen object “manually”.

It should be remembered that inept actions of parents can lead to much more serious complications and complicate the doctor’s further work.

Forecast

When correctly removing an object from the nose, the prognosis is generally positive. If the object had sharp parts or corners, then injury to the mucous membranes can lead to various types of complications. If treatment is not carried out, the risk of developing other pathological conditions increases significantly.

How to remove a foreign body in a child’s nose:

Foreign bodies of the larynx- foreign objects of various natures that accidentally end up in the larynx. Foreign bodies in the larynx can be small household objects, parts of food, living organisms, medical instruments or parts thereof. Foreign bodies of the larynx manifest themselves in varying degrees of severe respiratory disturbances, hoarseness or complete aphonia, paroxysmal cough, and pain in the larynx. Their diagnosis is based on a typical clinical picture, direct and indirect laryngoscopy, microlaryngoscopy, and radiological data. The treatment strategy consists of urgent removal of foreign bodies in the larynx. The removal technique depends on the size and location of foreign objects. This may be laryngoscopy, tracheotomy or laryngotomy.

General information

Foreign bodies of the larynx can enter it retrogradely from the stomach and esophagus during vomiting, from the bronchi and trachea during coughing.

In rare cases, foreign bodies of the larynx of iatrogenic origin occur. These include parts of medical instruments or removed tissues that can enter the larynx during certain dental procedures (treatment of caries, tooth extraction, dental implantation) or otolaryngological operations (tonsillectomy, adenotomy, correction of choanal atresia, removal of tumors of the pharynx and larynx, surgical treatment snoring).

Symptoms of foreign bodies in the larynx

Clinical manifestations of laryngeal foreign bodies may vary depending on their consistency, shape and size. Small foreign bodies when they enter the larynx cause a convulsive cough, cyanosis of the skin of the face and difficulty breathing. If a foreign body enters the larynx, reflex vomiting may occur. However, coughing up or vomiting a foreign object is observed only in rare cases. If a foreign body remains in the larynx, hoarseness of the voice develops and pain appears in the larynx. In some cases, pain occurs only when talking or coughing, in others it is constant and intensifies during conversation. Over time, coughing attacks recur again. Foreign bodies of the larynx located between the vocal folds prevent their closure and lead to aphonia.

Small foreign bodies of the larynx are initially not accompanied by respiratory problems and for a long time can manifest themselves only as hoarseness and periodic coughing. Over time, inflammation begins to develop in the area where they occur, leading to progressive swelling and narrowing of the lumen of the larynx, resulting in breathing difficulties. The addition of a secondary infection is accompanied by a rise in body temperature and the appearance of mucopurulent sputum.

Foreign bodies of the larynx of significant size and elastic consistency (removed adenoids, cotton swabs, poorly chewed pieces of meat) immediately obstruct the lumen of the larynx, leaving no space for air to pass through. In this case, in a matter of seconds, the victim’s face acquires a cyanotic hue, and extreme fear is expressed on it. The person begins to rush about, wheezes and makes convulsive breathing movements, which, due to obstruction, do not lead to air entering the respiratory tract. After 2-3 minutes, a coma occurs. If it was not possible to eject the foreign body or restore breathing through tracheostomy, then after 7-9 minutes respiratory and cardiac arrest may occur, leading to death. When respiratory and cardiac activity is restored a few minutes after the development of asphyxia, there is a danger that, as a result of prolonged oxygen starvation, the cortical centers of the brain are switched off.

Complications of foreign bodies in the larynx

Foreign bodies of the larynx often cause an inflammatory process at the site of their localization. The severity of the inflammatory reaction depends on the type of foreign bodies in the larynx, their infection and the duration of their presence in the larynx. The presence of foreign bodies in the larynx for a long time leads to the formation of contact ulcers, bedsores, granulomas and secondary infection. Sharp foreign bodies in the larynx can cause perforation and migrate to adjacent anatomical structures. The resulting perforation can cause mediastinal emphysema, and also contributes to the spread of secondary infection with the development of perilaryngeal or retropharyngeal abscess, perichondritis, mediastinitis, jugular vein thrombosis, sepsis.

Large foreign bodies of the larynx, as well as accompanying swelling of the mucous membrane and reflex spasm of the laryngeal muscles, can cause complete closure of the lumen of the larynx and asphyxia, leading to the death of the patient.

Diagnosis of foreign bodies in the larynx

Laryngeal foreign bodies accompanied by obstructive syndrome are diagnosed by characteristic clinical manifestations and the typical sudden onset of symptoms. If respiratory problems do not require emergency assistance, then to confirm the diagnosis, laryngoscopy is performed, during which it is possible not only to identify, but also to remove a foreign body of the larynx. In children, direct laryngoscopy is used, in adults - indirect.

For foreign bodies in the larynx that occur without breathing problems, patients usually turn to an otolaryngologist a few days after a foreign object enters the larynx. During this time, an inflammatory reaction and swelling of the laryngeal mucosa develops, preventing good visualization of the object. Therefore, in such cases, to detect a foreign body, they resort to tuberculosis, laryngeal papillomatosis.

Removal of laryngeal foreign bodies

Foreign bodies in the larynx must be removed as a matter of urgency. If asphyxia develops, tracheostomy is required to restore breathing. Subsequently, the patient is transported to the hospital, where the foreign body is removed using intubation anesthesia through a tracheostomy.

It is also advisable to remove non-obstructive foreign bodies of the larynx immediately, since swelling and inflammation of the larynx that develop over time make it much more difficult to remove foreign objects from it. Removal of foreign bodies of the larynx is carried out using laryngoscopy and only in stationary conditions. In adults, the removal procedure is carried out under local anesthesia; in children, it is carried out after the administration of phenobarbital, since the local administration of an anesthetic can reflexively cause them to stop breathing.

The most difficult task is the removal of foreign bodies of the larynx that have penetrated into the pyriform sinuses, ventricles and subglottic space. If it is impossible to remove them naturally, surgical treatment is indicated. The intervention is most often performed by tracheostomy. During this operation, a tracheostomy may be used to remove a foreign body from the larynx or push it upward. If wider access to the structures of the larynx is necessary to remove a foreign body and eliminate its complications (for example, to open an abscess), a laryngotomy is performed. Surgical removal of laryngeal foreign bodies can be complicated by cicatricial stenosis.

Removal of laryngeal foreign bodies is carried out against the background of sedative, anti-inflammatory and analgesic therapy. To prevent infectious complications, systemic antibiotic therapy is necessary.

Code according to the international classification of diseases ICD-10:

T17. 2 - Foreign body in the throat

Symptoms, course

A feeling of something foreign in the throat, pain and difficulty swallowing. With large foreign bodies, speech and breathing are impaired. With a long stay of a foreign body, an inflammatory process develops, sometimes with the formation of phlegmon.

Foreign body in the pharynx: Diagnosis

Diagnosis

diagnosed based on examination of the pharynx, palpation (small, deeply embedded foreign bodies) and x-ray examination (metal objects). Patients often complain of foreign body, and upon examination of the pharynx, only injuries from a swallowed object are visible. Scratches and abrasions of the mucous membrane can simulate the presence of a foreign body for a long time.

Foreign body in the pharynx: Treatment methods

Treatment

Foreign bodies are removed with cranked tweezers or forceps.

Diagnosis code according to ICD-10. T17. 2

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Treatment of foreign bodies of the larynx, even small ones, pose a danger to life, since a feature of the tissues of the larynx and its reflexogenic zones is the rapid occurrence of obstructive edema and almost instantaneous reflex laryngospasm. Therefore, in all cases of non-obstructive foreign bodies of the larynx, an ambulance should be immediately called or the victim should be transported by improvised transport to the nearest medical institution that has an endoscopist or an ENT specialist. Removal of foreign bodies is carried out only under visual control at the earliest possible time in order to prevent the occurrence of edema, which sharply complicates the extraction procedure and is fraught in some cases with traumatic complications (rupture of the mucous membrane, vestibular or vocal fold, subluxation of the cricoarytenoid cartilage, etc.). Only in the event of asphyxia when foreign bodies are localized in the laryngopharynx before the arrival of a health worker is it permissible to attempt to remove it with a finger, in which, however, it is possible to push the foreign bodies into the deeper parts of the larynx. Some authors recommend striking the back of the neck with the edge of the palm to dislocate foreign bodies and expel them. Probably, the mechanism of such removal is the transfer of shock wave energy to the internal tissues of the neck in the direction of foreign bodies and its propulsion into the oropharynx.
Asphyxia can be prevented by tracheotomy or intercricothyroidal laryngotomy, which restores life-saving breathing “at the tip of a scalpel.” Removal of wedged foreign bodies is carried out after tracheotomy, while the tracheostomy is used for intubation anesthesia. The position of the victim and the procedure for direct laryngoscopy are described above. In young children, direct laryngoscopy and removal of foreign bodies are performed without local anesthesia, which is fraught with reflex respiratory arrest, and under premedication with phenobarbital, which acts as an anticonvulsant, and chloral hydrate.
The most difficult to remove are foreign bodies wedged into the ventricles of the larynx, pyriform sinuses and subglottic space. Removal of such foreign bodies is carried out after a tracheotomy, and the tracheotomy opening can serve to push the foreign bodies upward or remove them through the tracheostomy. When foreign bodies in the larynx are removed, a reflex cessation of breathing may occur, for which the medical staff must be prepared, having at their disposal the necessary means to restore respiratory function (oxygen, carbogen, respiratory analeptics - lobeline, cititon, etc.).
For chronic foreign bodies of the larynx, thyrogomy with preliminary tracheotomy is indicated, especially in the presence of granulations, bedsores and ulcers or phenomena of chondroperichondritis, perforation of the larynx. This surgical intervention has two goals - removal of foreign bodies and sanitizing manipulations to eliminate secondary complications.
In all cases of foreign bodies in the larynx, the prescription of broad-spectrum antibiotics is indicated to prevent secondary complications, as well as sedatives, analgesics and, in some cases, tranquilizers.