Ingested foreign bodies pose a unique challenge in medical practice, especially when lodged in the oesophagus. While endoscopic retrieval is the standard treatment, certain cases require more innovative approaches.

This paper reports the case of a patient who intentionally ingested a butter knife that lodged in the thoracic oesophagus. After multiple endoscopic attempts, a lateral neck oesophagotomy, aided using a Hopkins rod camera and an improvised trochar as a protective port, was performed.

The foreign body was successfully extracted without causing oesophageal perforation. The patient was made nil by mouth, with nasogastric feeding only until a swallow assessment after one week. The patient was discharged and recovered well.

This case illustrates a successful, innovative approach to removing a foreign body in a high-risk patient, highlighting the significance of adaptability in surgical practice. It emphasises the need for individualised approaches based on the patient's history, the nature and location of the foreign body, and associated risks.

Bronchoscopic removal of a foreign body is a common emergency procedure in paediatric otolaryngology. It is potentially life-threatening, as complete airway obstruction caused by the foreign body can lead to hypoxic cardiac arrest during the manipulation of the object.

This paper presents a child who had aspirated a foreign body that could not be extracted conventionally via rigid bronchoscopy in the first instance. Subsequently, it was extracted at repeat bronchoscopy under controlled respiratory conditions maintained by an extracorporeal gas exchange circuit – extracorporeal membrane oxygenation, using a polypropylene hollow fibre oxygenator commonly employed in cardiac surgery (rather than a more expensive polymethyl pentene oxygenator commonly used in extracorporeal membrane oxygenation).

Extracorporeal membrane oxygenation use can be considered in exceptional cases of upper airway emergencies, even in resource-poor settings, and can avoid more hazardous thoracotomy and bronchotomy procedures.

The increased popularity of reusable drinking bottles may have safety implications when used by children. This paper discusses the lessons learnt from managing two cases of children presenting to our ENT department who required surgical intervention for complications arising from their use.

This paper presents a case series of two five-year-old children who attended the emergency department with circumferential entrapment of their tongue within plastic drinking bottle lids of similar design. The unique anaesthetic and surgical challenges surrounding these cases are discussed.

These represent the only reported cases of circumferential entrapment of the tongue by a foreign body requiring general anaesthesia where orotracheal intubation was contraindicated. A creative general anaesthetic approach was taken using ketamine and Optiflow high-flow nasal oxygen therapy. A reproducible surgical technique using powered cutting instruments is also discussed.

To explore the factors associated with the operative duration for paediatric tracheobronchial foreign body removal by rigid bronchoscopy, and to analyse the learning curve for mastery of the rigid bronchoscopy skill.

A retrospective study was performed of paediatric cases of tracheobronchial foreign body removal by rigid bronchoscopy in our department from January 2007 to July 2019. Multivariate Cox regression analysis was used to analyse the factors associated with the operative duration. In addition, the learning curves for two doctors were evaluated by curve-fitting regression analysis.

A total of 410 paediatric cases of tracheobronchial foreign body removal by rigid bronchoscopy were evaluated. The operative duration was significantly influenced by the skill of the doctor. The learning curves for both doctor A and doctor B demonstrated two typical phases: an initially rapidly changing learning phase followed by a steady consolidation phase.

The operative duration for paediatric tracheobronchial foreign body removal by rigid bronchoscopy was associated with the skill of the doctor. In order to fully master the rigid bronchoscopy technique, doctors should perform a minimum number of procedures to pass the learning phase and reach the consolidation phase.

Foreign bodies in the ear, nose and throat commonly necessitate emergency department visits.

This retrospective study was conducted on emergency department visits from January 2010 to December 2019 to determine characteristics and clinical prognoses of ENT patients. Patients were divided into three groups according to foreign-body entry route; patient characteristics and clinical findings were compared between groups.

Of 676 142 emergency department visits, 10 454 were because of ENT-related foreign bodies. The mean (± standard deviation) age of subjects was 24.0 (± 23.4) years, and 5176 patients were male (49.5 per cent). The most common entry route was the mouth (74.5 per cent). Most patients (97.1 per cent) were discharged after emergency treatment. Intensive care and in-hospital mortality occurred only in the mouth group.

Clinical findings differ depending on foreign-body entry route. After emergency treatment, most patients were discharged; some cases presented serious complications.

Oesophageal foreign body removal may be challenging. If a foreign body is sufficiently high risk and cannot be retrieved via oesophagoscopy, laparotomy may be required as the foreign body migrates distally.

This paper presents the use of the plastic tubing from an intravenous giving set, combined with rigid oesophagoscopy grasping forceps, in order to improve purchase and obtain sufficient traction on a large, smooth, metallic distal oesophageal foreign body (knife).

This method offers an option for removal of oesophageal foreign bodies that may be rendered challenging with traditional metal grasping forceps given the lack of purchase and traction afforded by a ‘metal on metal’ grip, potentially avoiding the need for open surgery.

This case series, conducted during the coronavirus disease 2019 pandemic, investigates the impact of leaving aural foreign bodies in situ for a prolonged period of time, including the risk of complications and success rates of subsequent removal attempts.

A retrospective study of aural foreign body referrals over a six-month period was carried out.

Thirty-four patients with 35 foreign bodies were identified (6 organic and 29 inorganic). The duration of foreign bodies left in situ ranged from 1 to 78 days. Four patients suffered from traumatic removal upon initial attempts. First attempts made by non-ENT specialists (68.8 per cent) all failed and were associated with a high risk of trauma (36.4 per cent).

Because of the coronavirus disease 2019 pandemic, this is the first case series to specifically investigate the relationship between the duration of aural foreign bodies left in situ and the risk of complications. Our data suggest that prolonged duration does not increase the incidence of complications.

This paper reports the dangers of an ingested metal wire bristle from a barbeque brush, which resulted in oesophageal perforation.

A 49-year-old gentleman presented to the emergency department with foreign body sensation and odynophagia after having consumed barbequed lamb for lunch. Computed tomography of the neck demonstrated a thin linear opacity near the thoracic inlet. The object could not be visualised on emergent rigid oesophagoscopy. Subsequent neck exploration enabled localisation of a retropharyngeal abscess and a thin wire bristle from a barbeque brush.

Always consider the utensils employed in food preparation as a differential in ingested foreign bodies. Thin wire objects have a high propensity to migrate and result in complications, hence urgent intervention is vital.

The occurrence of retained ear mould impression material is rare and can lead to complications. The current case report describes one such complication, where the silicone impression material used to take the impression of the ear canal flowed into the middle ear through the pre-existing tympanic membrane perforation. Five days later, the patient presented with worsened hearing and blood-tinged discharge from the ear. Ear microscopy revealed a greenish foreign body in the middle ear.

The foreign body was removed by tympanotomy and the perforation repaired using a temporalis fascia graft. A hearing aid was prescribed after ensuring that the perforation had healed.

It is essential that the audiologist perform a basic otological examination before prescribing a hearing aid and preparing an ear mould. A clinical approach algorithm for audiologists, for prior to taking an impression, is suggested.

By nature of their specialty, otolaryngologists are disproportionately exposed to coronavirus disease 2019 through aerosol-generating procedures and close proximity to the oropharynx during examination.

Our single-centre, retrospective study analysed the pertinence of guidelines produced by ENT UK to improve the investigation and management of suspected upper aerodigestive fish bone foreign bodies during the coronavirus disease 2019 pandemic.

Our results demonstrated 43.3 per cent (n = 13) low-risk cases and 56.7 per cent (n = 17) moderate-risk cases. Nine fish bones (two low risk, seven moderate risk) were found; none of these were confirmed with X-ray and three (moderate risk) required nasoendoscopy for diagnosis. One patient required rigid pharyngoscopy.

This study confirms that soft tissue neck X-ray and flexible nasoendoscopy are unnecessary in low-risk cases; however, early nasoendoscopy in higher suspicion cases is appropriate. Recommendations are made about the long-term sustainability of these guidelines, and additional measures are encouraged that relate to repeat attendances and varying prevalence of coronavirus disease 2019 in the hospital catchment area.

Coronavirus disease 2019, a highly transmissible respiratory infection, has created a public health crisis of global magnitude. The mainstay of diagnostic testing for coronavirus disease 2019 is molecular polymerase chain reaction testing of a respiratory specimen, obtained with a viral swab. As the incidence of new cases of coronavirus disease 2019 increases exponentially, the use of viral swabs to collect nasopharyngeal specimens is anticipated to increase drastically.

This paper draws attention to a complication of viral swab testing in the nasopharynx and describes the premature engagement of a viral swab breakpoint, resulting in impaction in the nasal cavity.

This case highlights a possible design flaw of the viral swab when used to collect nasopharyngeal specimens, which then requires an aerosol-generating procedure in a high-risk patient to be performed. The paper outlines a safe technique of nasal foreign body removal in a suspected coronavirus disease 2019 patient and suggests alternative testing materials.

This study aimed to analyse the common presentations and treatment outcomes in cases involving nasal foreign bodies.

A retrospective study was carried out over three years, from January 2014 to December 2017. Patient biodata, clinical presentation, nasal foreign body type and management outcome data were obtained from the medical records and analysed.

A total of 341 cases were analysed. The average patient age was 3.7 ± 1.2 years (range, 1–19 years).Of the nine cases involving button batteries, septal perforation was initially seen in four cases and three cases had subsequent septal perforation.

Only button battery nasal foreign bodies were associated with increased septal perforation. Use of physiological seawater nasal spray was found to reduce the likelihood of septal perforation. Most nasal foreign bodies could be removed under local anaesthesia.

Endoscopic ear surgery is a technique that is growing in popularity. It has potential advantages in the low-resource setting for teaching and training, for the relative ease of transporting and storing the surgical equipment and for telemedicine roles. There may also be advantages to the patient, with reduced post-operative pain, facilitating the ability to complete procedures as out-patients.

Our Ear Trainer has previously been validated for headlight and microscope otology skills, including foreign body removal and ventilation tube insertion, in both the high- and low-resource setting. This study aimed to assess the Ear Trainer for similar training and assessment of endoscopic ear surgery skills in the low-resource setting. The study was conducted in Uganda on ENT trainees.

Despite a lack of prior experience with endoscopes, with limited practice time most participants showed improvements in: efficiency of instrument movement, steadiness of the camera view obtained, overall global rating of the task and performance time (faster task performance).

These results indicate that the Ear Trainer is a useful tool in the training and assessment of endoscopic ear surgery skills.

The provision of healthcare education in developing countries is a complex problem that simulation has the potential to help. This study aimed to evaluate the effectiveness of a low-cost ear surgery simulator, the Ear Trainer.

The Ear Trainer was assessed in two low-resource environments in Cambodia and Uganda. Participants were video-recorded performing four specific middle-ear procedures, and blindly scored using a validated measurement tool. Face validity, construct validity and objective learning were assessed.

The Ear Trainer provides a realistic representation of the ear. Construct validity assessment confirmed that experts performed better than novices. Participants displayed improvement in all tasks except foreign body removal, likely because of a ceiling effect.

This study validates the Ear Trainer as a useful training tool for otological microsurgical skills in developing world settings.

Chronic suppurative otitis media is a neglected condition affecting up to 330 million people worldwide, with the burden of the disease in impoverished countries. The need for non-governmental organisations to hardwire training into their programmes has been highlighted. An ear surgery simulator appropriate for training in resource-poor settings was developed, and its effectiveness in facilitating the acquisition of headlight and microsurgical skills necessary to safely perform procedures via the ear canal was investigated.

Face validity was assessed via questionnaires. Six tasks were developed: a headlight foreign body removal task, and microscope tasks of foreign body removal, ventilation tube insertion, tympanomeatal flap raising, myringoplasty and middle-ear manipulation. Participants with varying ENT experience were video-recorded performing each task and scored by a blinded expert observer to assess construct validity.

Face validity results confirmed that our Ear Trainer was a realistic representation of the ear. Construct validity results showed a statistically significant trend, with experts performing the best and those with limited experience performing better than novices.

This study validates our Ear Trainer as a useful training tool for assessing headlight and microsurgical skills required to perform otological procedures.

Ingested foreign bodies are common emergencies encountered in otolaryngology practice. The vast majority can be managed with endoscopic removal. Migration of foreign bodies into the paraglottic space is a rare event that often necessitates using a more invasive procedure for removal.

A 68-year-old man presented with sore throat and odynophagia 4 days after ingesting a fish bone.

A computed tomography scan revealed a 2.5 cm linear foreign body embedded in the larynx within the right paraglottic space. The patient underwent endoscopic examination and transcervical exploration of the paraglottic space via a posterolateral approach, with successful removal of the foreign body on the second attempt.

This is the first case report of an ingested paraglottic space foreign body managed by transcervical exploration using a posterolateral approach to the paraglottic space.

Animate foreign bodies in the ear are frequent occurrences in otology practice. Such foreign bodies may lead to hazardous complications.

This paper describes a retrospective study of six patients with a recent history of an insect in the ear who presented with various complications following intervention received elsewhere.

An insect was retrieved from the external auditory canal in four cases and from the antrum in two cases. The patients presented with progressive otological complications: two patients who presented with orbital apex syndrome and cavernous sinus thrombosis succumbed to the disease; three patients suffered sensorineural hearing loss; and two patients had persistent facial palsy. One patient with sigmoid sinus thrombosis, who presented early, experienced complete recovery.

Insects in the ear can lead to hazardous complications. Animate foreign bodies should preferably be managed by a trained otologist, even in an emergency setting. Patients with delayed presentation and complications have a guarded prognosis.

Foreign body aspiration is common and potentially life threatening. Although rigid bronchoscopy has the potential for serious complications, it is the ‘gold standard’ of diagnosis. It is used frequently in light of the inaccuracy of clinical examination and chest radiography. Computed tomography is proposed as a non-invasive alternative to rigid bronchoscopy.

This study aimed to evaluate the accuracy and safety of computed tomography used in the diagnosis of suspected foreign body aspiration, and compare this with the current gold standard, in order to examine the possibility of using computed tomography to reduce the number of diagnostic rigid bronchoscopies performed.

The study comprised a review of literature published from 1970 to 2013, using the PubMed, Scopus, Web of Knowledge, Embase and Medline electronic databases.

The sensitivity for computed tomography ranged between 90 and 100 per cent, with four studies demonstrating 100 per cent sensitivity. Specificity was between 75 and 100 per cent. Radiation exposure doses averaged 2.16 mSv.

Computed tomography is a sensitive and specific modality in the diagnosis of foreign body aspiration, and its future use will reduce the number of unnecessary rigid bronchoscopies.

Multidetector computed tomography virtual bronchoscopy is a non-invasive diagnostic tool which provides a three-dimensional view of the tracheobronchial airway. This study aimed to evaluate the usefulness of virtual bronchoscopy in cases of vegetable foreign body aspiration in children.

The medical records of patients with a history of foreign body aspiration from August 2006 to August 2010 were reviewed. Data were collected regarding their clinical presentation and chest X-ray, virtual bronchoscopy and rigid bronchoscopy findings. Cases of metallic and other non-vegetable foreign bodies were excluded from the analysis. Patients with multidetector computed tomography virtual bronchoscopy showing features of vegetable foreign body were included in the analysis. For each patient, virtual bronchoscopy findings were reviewed and compared with those of rigid bronchoscopy.

A total of 60 patients; all children ranging from 1 month to 8 years of age, were included. The mean age at presentation was 2.01 years. Rigid bronchoscopy confirmed the results of multidetector computed tomography virtual bronchoscopy (i.e. presence of foreign body, site of lodgement, and size and shape) in 59 patients. In the remaining case, a vegetable foreign body identified by virtual bronchoscopy was revealed by rigid bronchoscopy to be a thick mucus plug. Thus, the positive predictive value of virtual bronchoscopy was 98.3 per cent.

Multidetector computed tomography virtual bronchoscopy is a sensitive and specific diagnostic tool for identifying radiolucent vegetable foreign bodies in the tracheobronchial tree. It can also provide a useful pre-operative road map for rigid bronchoscopy. Patients suspected of having an airway foreign body or chronic unexplained respiratory symptoms should undergo multidetector computed tomography virtual bronchoscopy to rule out a vegetable foreign body in the tracheobronchial tree and avoid general anaesthesia and invasive rigid bronchoscopy.