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Question 13 Foreign bodies of the ear
most often observed in children, stuffing various small objects (paper, fruit seeds, peas, sunflower seeds, beads, etc.) into the external auditory canal. In adults, there are pieces of cotton wool, fragments of matches, etc. Various insects (bugs, cockroaches, flies, etc.) can also get into the ear.
Symptoms, course. Small foreign bodies with smooth walls in the absence of an injury to the walls of the ear canal may not cause complaints in patients. Foreign bodies with sharp edges and especially live insects cause unpleasant, and sometimes painful sensations, cause pain and tinnitus.
Treatment. Before removing a foreign body, the ear must be examined to determine the nature of the foreign body. Insects are usually killed by dropping 2-3 drops of liquid oil or alcohol into the ear, then they are removed with tweezers or washing the external auditory canal with warm water from the Janet syringe.
Other foreign bodies are removed by a similar method. Rounded objects, such as beads, cannot be removed with tweezers, as this can lead to pushing them into deeper sections of the ear canal. Swelling foreign bodies of plant origin (peas, beans) are dehydrated before removal by repeated infusion of alcohol into the ear. Ear washing is the safest method, but it is contraindicated during perforation of the eardrum (in order to avoid purulent otitis media), with foreign bodies completely obstructing the bony section of the ear canal (the water jet pushes them even deeper). If leaching is ineffective, then the foreign body under the control of vision is removed with a small hook.
Foreign bodies of the nose, like foreign bodies of the ear, are most often found in children. In the nasal cavity, pieces of food masses that get there through the nasopharynx during vomiting can also get stuck. Sometimes, around the foreign body, which has been in the nasal cavity for a long time, calcareous and phosphoric salts are deposited, as a result of which the so-called nasal stone is formed - rhinolitis.
Symptoms, course. Unilateral difficulty in breathing through the nose and purulent discharge from one half of the nose, less often nosebleeds. For recognition, rhinoscopy, palpation with a probe and radiography (metal bodies) are used.
Treatment. If the foreign body cannot be removed by blowing, then it is removed with a blunt hook. Flat foreign bodies (coin, matches, paper, etc.) can be removed with tweezers. You should not be seduced by the ease of removing with tweezers or forceps, it would seem, closely spaced foreign bodies of a rounded shape, as they often slip out and push further.
Large rhinoliths should be crushed with nasal forceps before removal and removed in parts.
Foreign bodies of the pharynx, as a rule, come from food (fish bones, husks from cereals, pieces of wood, etc.), fragments of dentures, pins, nails (at tailors, shoemakers) are less likely to get stuck. In case of insufficient chewing and hasty swallowing, large pieces of food can get stuck over the esophagus, close the entrance to the larynx and cause asphyxiation. Contribute to the ingress of foreign bodies conversation, laughter while eating. Most often, acute foreign bodies get stuck in the throat, tonsils and root of the tongue, less often in other parts of the pharynx.
Symptoms, course. Sensation of something else in the throat, pain and difficulty swallowing. With large foreign bodies, speech and breathing are disturbed. With a long stay of a foreign body, an inflammatory process develops, sometimes with the formation of phlegmon. The diagnosis is made on the basis of examination of the pharynx, palpation (small, deeply invaded foreign bodies) and X-ray examination (metal objects). Often patients complain of a foreign body, and when examining the pharynx, only injuries from a swallowed object are visible.
Mucosal scratches and abrasions can simulate the presence of a foreign body for a long time.
Treatment. Foreign bodies are removed with cranked forceps or forceps.
Foreign bodies of the larynx. Foreign bodies rarely get stuck in the larynx (most often they slip through the glottis into the trachea and bronchi).
Observed, as a rule, in children. In the larynx, foreign bodies with sharp edges and ends (fish and meat bones, walnut shells, egg shells, etc.) are usually found, as well as relatively large objects that are stuck in the lumen of the glottis or restrained in the back space.
Symptoms, course depend on the size and localization of foreign bodies. Most
frequent signs - bouts of severe coughing, pain in the larynx, hoarseness of the voice up to aphonia. Depending on the degree of closure of the glottis or due to the associated edema of the subglottis, respiratory failure occurs or asphyxia develops.
Treatment. You should carefully examine the larynx and quickly remove the foreign body. With severe phenomena of laryngeal stenosis, a tracheostomy is indicated.
Foreign bodies of the trachea and bronchi. They can be any small objects: sunflower and watermelon seeds, buttons, pins, hooks, nails, buttons, paper clips, beans, peas, etc. In most cases, they occur in childhood, getting there from the oral cavity with a deep breath . Rarely, foreign bodies can enter the lower respiratory tract from the gastrointestinal tract (with vomiting, round worms popping up).
Contributing moments are laughter, crying, coughing, sleeping, fainting, intoxication, weakening of the cough reflex.
Symptoms and course depend on the nature, shape, size of the foreign body, its location, as well as the age and individual characteristics of the patient. At the time of aspiration, a reflex spasm of the glottis occurs, an asthma attack occurs with pronounced cyanosis of the skin and often loss of consciousness.
The attack of suffocation relatively quickly disappears and a strong cough appears.
Foreign bodies of the trachea, as a rule, are not fixed, but are running. If a trachea gets into the bifurcation area, a coughing attack occurs, the foreign body throws up and hits the lower surface of the vocal folds, then you can hear a characteristic popping sound; in addition, during a ballot, a foreign body is sometimes infringed between the vocal folds. This leads to suffocation. Of particular danger are foreign bodies that can swell (beans, peas), causing obstruction of the lumen of the trachea. Foreign bodies of the bronchi in 80% of cases fall into the right bronchus, which is almost a direct continuation of the trachea. Dyspnea and cough are characteristic. If one of the lungs functions normally, then shortness of breath is mild. With complete obstruction of the lumen of one of the main bronchi, atelectasis of the lung occurs.
Another lung is expanding emphysema. Sometimes a foreign body can act as a valve: when inhaling, air passes freely through the bronchus, and exhalation is difficult. In this case, the phenomena of emphysema develop. For diagnosis, X-ray examination of the chest organs is of great importance.
Treatment. Rapid removal of a foreign body from the trachea (with direct laryngoscopy or with tracheoscopy). If this fails, then a tracheostomy is performed followed by removal of the foreign body. A foreign body from the bronchus is removed using bronchoscopy.
Prevention A large role belongs to health education. Remind parents and staff of kindergartens of the dangers of small items for young children. It is important to monitor the behavior of children during feeding.
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Question 13 Foreign bodies of the ear
- FOREIGN BODIES OF THE EAR
Foreign bodies in the external auditory canal are more common in children who, during games, put various small objects (buttons, beads, seeds, small bones, balls, pebbles, peas, beans, paper, parts from toys, grains, etc. into their ears. ) In adults, foreign bodies may have fragments of matches, pencil rods, pieces of cotton, stuck in the ear canal at the time of the toilet
- Foreign bodies of the outer ear
Clinical picture Foreign bodies of the outer ear are most often observed in children who, playing with various small objects (pebbles, cherry stones, beads, buttons, sunflower seeds, peas, paper balls, etc.), put them into their ears. In adults, foreign bodies can be matches, pieces of cotton wool. There are also living foreign bodies (insects). Symptoms depend on the magnitude.
- EAR INJURY, FOREIGN BODY OF THE EAR
In case of an external ear injury, first aid is similar to first aid for injuries. Damage to the eardrum can occur during explosions, diving, during diving operations. The rupture of the membrane is accompanied by pain, hearing loss, minor bleeding from the ear. First aid: - insert a sterile cotton swab into the external auditory meatus; - put on the ear
- Foreign bodies
Foreign bodies of the ear, nose, pharynx, and less commonly, the larynx, trachea, and bronchi, are more common. Foreign bodies of the ear are more common in children (paper, pencils, fruit bones), in adults - foreign bodies with sharp edges (fragments of matches) and insects. Rinsing with water is contraindicated during perforation of the tympanic membrane and complete obstruction of the lumen by a foreign body. Insects are killed before removal,
- Foreign bodies of the nose
Clinical picture Foreign bodies of the nose are more common in children who, during the game, insert various small objects into their nose (beads, buttons, sunflower seeds, peas, berry seeds, coins, pieces of paper, etc.). Foreign bodies can get into the nose during combat and industrial injuries of the face (shell splinters, bullets, pieces of glass, stones, molten metal), as well as with vomiting
- Foreign bodies
Foreign bodies in the throat Cause Foreign bodies often fall into the throat with food. It can be fish and meat bones, glass fragments, pieces of plastic, large pieces of food. Foreign objects can also get into the mouth - pins, nails, buttons, dentures. Foreign bodies enter the mouth as a result of rapid absorption of food, sudden laughter or coughing during meals, and
- Foreign bodies of the external auditory meatus
Foreign bodies in the external auditory canal are most often found in children when during the game they push various small objects (buttons, balls, pebbles, peas, beans, paper, etc.) into their ears. However, in adults, foreign bodies are often found in the external auditory canal. They may be fragments of matches, pieces of cotton, stuck in the ear canal at the time of clearing the ear from
- Foreign bodies of the pharynx
Foreign bodies of the pharynx often come with food (fish and meat bones, glass fragments, pieces of wire, pieces of meat, lard). Foreign bodies can also be objects that accidentally fall into the mouth (pins, nails, buttons), dentures. Less common are living foreign bodies (leeches, roundworms). The ingestion of foreign bodies in the throat can be caused by such predisposing moments as fast food,
- Foreign bodies of the larynx
Foreign bodies of the larynx, trachea and bronchi are more common in children. They enter the respiratory tract if the child inadvertently eats and adults do not control the behavior of children. Among foreign bodies, sunflower seeds, watermelon, pumpkin, pieces of carrots, coins, pins, parts of fountain pens, toys, etc. are more common. In adults, foreign bodies enter the respiratory tract with careless and inattentive
- Foreign bodies of the larynx
Meat and fish bones, needles, pins, buttons, eggshells, dentures, coins, small parts of toys usually enter the larynx from the mouth, less often from the stomach when vomiting. Such foreign bodies are much less common, such as parts of broken surgical instruments, tissue removed during surgery (adenoids, palatine tonsil, polyp), as well as living foreign bodies (leeches, roundworms,