ENT foreign bodies - emergency medicine revision
This concise guide covers assessment and early management of foreign bodies (FBs) in the ear, nose and throat for the emergency clinician. It highlights immediate airway priorities, presentations that need urgent ENT/anaesthetic involvement, safe bedside techniques for simple removals, and common exam pitfalls.
Key principles
- Most ENT foreign bodies are paediatric and are removable in the ED, but high‑risk scenarios require urgent specialist input: button/coin batteries, airway obstruction, sharp or glass objects, objects embedded in tissue, or failed removal after brief attempts.
- Do not persist with prolonged or blind attempts; stop after 1-2 careful attempts and escalate if unsuccessful or if complications arise (NICE NG98).
- Treat any round metallic object in the nose or ear as a possible button battery until proven otherwise; batteries can cause rapid mucosal necrosis and demand expedited removal and ENT/A&E involvement (GOV.UK).
- For suspected airway obstruction follow the Resuscitation Council UK choking/BLS algorithms and call for immediate help (Resuscitation Council UK).
Initial assessment and priorities
- Primary survey: follow ABCs. Airway compromise with stridor, drooling, severe dysphagia, voice change or respiratory distress is life‑threatening and requires immediate management and early anaesthetics/ENT involvement.
- Focused history: record time of insertion, object type (battery/organic/sharp), symptoms, whether insertion was witnessed, prior removal attempts, and any bleeding or coagulopathy.
- Examination: maximise patient comfort and...
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