Hook, Line, and Sinker: Unusual and Interesting Foreign-Body Cases

Inadvertent Whistling

I took out a whistle from a patient’s bronchus. When the patient expired air, it whistled.

Nasal Bone

A child who had been in a car accident was hospitalized for multiple facial and extremity fractures and had been intubated for a period of time. He then was extubated and about 6 weeks later he came to my office. He had loud noisy breathing that sounded as if he had a mass in his trachea. I scoped him and saw a mass below the vocal cords and I thought, This must be a reaction from the intubation. I took him to the OR and when I took out the mass it appeared pink and fleshy. When I poked around in the flesh I found a piece of his nasal bone. During the car accident it had smashed his nasal bone and he had aspirated it, and a reaction occurred around the bone.

Three Coins in an Esophagus

Coins are frequent-but I’ve taken out three coins at a time.

Monster in My Nose

When I was a resident, a five-year-old patient came in and said he had a monster living in his nose. The mother had heard him say this repeatedly and did not pay much attention to it. But eventually the odor being emitted from the child’s nose was so bad that the regular babysitter refused to stay with the child. The case fit the typical history of unilateral foul-smelling drainage. I examined the nose and suctioned out the foul mucus, and I thought I saw a sort of a pinkish mass. I extracted something that appeared to be soft and spongy, and it was bleeding. I was afraid I had biopsied a tumor connected to his brain. I ran, literally, carrying the tissue, to the pathology lab. That soft, spongy mass turned out to be-a sponge.

Ellen M. Friedman, MD

Professor and Chief, Otolaryngology-Head and Neck Surgery Service, Texas Children’s Hospital, Baylor College of Medicine, Houston

Tips for Foreign Body Diagnosis and Treatment

All of us who have been in otolaryngology practice for a number of years have seen unusual things. If a patient has unilateral purulent nasal discharge, always consider one of two diagnoses: (1) that there is a foreign body present, regardless of the patient’s age; and (2) choanal atresia. In a toddler, it is almost always going to be a foreign body as opposed to choanal atresia. If it is an acute onset of purulent nasal discharge, it may be a button (disc) battery, which can lead to erosion of the nasal septum, nasal collapse, and chronic anatomic structural problems. If there is any chance of it being a button battery, whether it is in the nose, ear, or esophagus, that is an emergent event. If you cannot remove the foreign body with the patient awake, then you need to give the child general anesthesia. If the patient has a foreign body in one orifice, remember to examine every other orifice. Just because a child may say that they put a bead in the right ear, you still may find something in the left ear, and one of the nostrils as well.