Leech is an uncommon nasal foreign body, which can cause epistaxis. It is an aquatic segmental
worm living in fresh water most commonly in tropical areas. Once it is attached in the nose, it will
secrete an anticoagulant enzyme named hirudin, and that will result in continuous bleeding more
than from a normal wound even after it is removed. We present a case of a live leech in the nose
that caused unilateral epistaxis in a patient with a recent history of jungle trekking.
A middle-aged lady presented with a three-month history of chronic cough. After a long and extensive investigation, CT thorax revealed collapse consolidation of the right lower lung lobe and bronchoscopy showed a polypoidal tumour within the involved bronchus. Thoracotomy and segmental lung resection revealed a peanut in the airways of the fibrotic and infected lung tissue. In view of the rarity of the food particle aspiration in a healthy adult, the delay in presentation and diagnosis in our patient, we would like to highlight this particular case. A high index of suspicion of FBA is necessary to avoid unnecessary anxiety, extensive investigations and overzealous treatment as well as to promote lung conservation.
Tinnitus is not a disease per se but it is a symptom. It can be either subjective or objective type and the
underlying cause varies such as tumour, infection, vascular abnormality or Meniere’s disease. Foreign body in the external ear is a common presentation especially in children. However, foreign body in the middle ear manifested with only symptom of tinnitus is a rare and unexpected presentation. Foreign body in the middle ear are commonly due to iatrogenic cause such as complication of myringotomy and ventilation tube insertion surgery. There are reported cases of complications of myringotomy and ventilation tube insertion, and they typically presented with the ear infection manifestation, myringosclerosis or permanent perforation of tympanic membrane. Currently, there are only few reported cases in literatures of foreign body in the middle ear following complication of medial migration of ventilation tube into a middle ear with intact tympanic membrane.
Foreign body aspiration is commonly described in infants and children. However, recently, a new high-risk group was identified among young women, especially those from the Muslim population who wear the traditional hair scarf. This is due to the habit of holding the scarf pin in between the lips to free hands to adjust the scarf more easily. Talking, laughing, or coughing while fixing the scarf may result in inadvertent inhalation of the pin into the tracheobronchial tree. We present a case of scarf pin inhalation and the challenges encountered in managing this patient during the successful removal of the pin via flexible bronchoscopy under fluoroscopy guidance. This particular case was technically challenging for us as the sharp tip of the needle was pointing upward and piercing the bronchial mucosa.
Foreign body aspiration is commonly described in infants and children. However, recently, a new
high-risk group was identified among young women, especially those from the Muslim population
who wear the traditional hair scarf. This is due to the habit of holding the scarf pin in between the
lips to free hands to adjust the scarf more easily. Talking, laughing, or coughing while fixing the
scarf may result in inadvertent inhalation of the pin into the tracheobronchial tree. We present a
case of scarf pin inhalation and the challenges encountered in managing this patient during the
successful removal of the pin via flexible bronchoscopy under fluoroscopy guidance. This particular
case was technically challenging for us as the sharp tip of the needle was pointing upward and
piercing the bronchial mucosa.
A foreign body (FB) in the upper aerodigestive tract is a common clinical problem that presents as as acute emergency. Sharp FB, such as fish bone or chicken bone, commonly lodges in the tonsil, base of tongue, vallecula or pyriform fossa. Dislodgement of a FB into the laryngopharynx is very rare and specifically onto the vocal cord is extremely uncommon. This case report illustrates a rare case of a sharp FB that was dislodged into the airway and stuck on to the right vocal cord, which was removed under local anaesthesia.
Susuk, or charm needles, are inserted and worn subcutaneously in the face and other parts of the body, as they are believed to enhance beauty and youth, and for many other reasons such as treatment of headache, aches and pains in the joints, back or abdomen. The practice of inserting susuk is a traditional belief, genuinely cultural and superstitious, and common in the south-east Asian region. We present 13 cases of susuk, which was found incidentally on the radiographs as the patients came for various types of treatment at our centre.
Endobronchial tuberculosis is an uncommon manifestation involving the tracheobronchial tree. The clinical presentation is typically non-specific. We report this unusual complication of pulmonary tuberculosis initially diagnosed as foreign body in a 16-month-old child.
Foreign bodies (FB) are most often lodged in the upper digestive tract and amongst the common encounter in outpatient clinic. In most instances, the ingested FB passes uneventfully through the gastrointestinal tract without any harm but in certain cases, it can migrate extraluminally and lead to serious complication. Long standing migrated FB can cause devastating complications like neck abscess and injuries to the major blood vessels. In the present case, a wooden toothpick had migrated to the soft tissue of the neck. A careful and detailed history with clinical-radiographic investigation helped to locate the ingested FB and aided in its successful removal.
Study site: Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Taiping, Perak, Malaysia
A tooth in the nasal cavity is an uncommon phenomenon. The exact mechanism is unclear, and patients may present with non-specific nasal symptoms. We encountered a 24-year-old patient with history of cleft palate repair, presenting to us with unilateral nasal discharge not improving with conventional medications. Rigid nasal endoscopy revealed a rhinolith-like foreign body at the floor of the left nasal cavity. Removal of the rhinolith was done under general anesthesia, and it turned out to be an intranasal tooth. Intranasal tooth is often misdiagnosed due to its non-specific symptoms. Detailed dental and oropharyngeal examination as well as imaging studies are essential in diagnosing an intranasal tooth. Early surgical removal is the mainstay of treatment in order to prevent further complications. Patients with unilateral nasal symptoms not responding to conventional treatment require proper ear, nose, and throat (ENT) evaluation to rule out other pathology.
Foreign body ingestion among children is common and most usually pass through the gastrointestinal tract without requiring any intervention. Magnets, however, pose a greater threat especially when more than one are ingested. We report a case of multiple bowel perforation secondary to ingestion of magnetic beads in a 3-year-old.
Penetrative neck injury can cause potentially fatal damage to the neck. Removing those fully embedded small foreign bodies secondary to ballistic trauma can be technically challenging. Neck exploration under direct vision may cause more local tissue damage or dislodge the foreign body further. We discussed a case where a small foreign body embedded in the neck caused by ballistic trauma. Successful removal of the foreign body guided by rigid endoscope thru the neck wound was also discussed as a useful tool as it was not ferromagnetic and image intensifier was not available.
Various complications are associated with the use of indwelling voice prostheses. We present problems faced by a patient with his Voice-Master prosthesis, the ingestion of the prosthesis followed by a potentially fatal aspiration. The Voice-Master is unique in that in can be re-inserted. The safety strap is removed after primary insertion once the prosthesis is secure. However, during re-insertions this safety mechanism is no longer present. Therefore we recommend the placement of a temporary stitch or tie to minimize the risks of ingestion or aspiration of the prosthesis during re-insertions.
Aspiration of a foreign body is rare in school-age children. This reports the 21-day journey of an 8-year-old girl who had a foreign body aspiration. She presented to our hospital after five days of respiratory distress. She subsequently required mechanical ventilation and was supported with triple inotropes. After 18 days, a foreign body was removed via rigid bronchoscopy, followed by a rapid recovery of the patient.
A foreign body in the nose is a common referral dealt by the otolaryngologist on daily basis. Here we report a case of a 5-year-old girl who was referred from a primary care center with complaints of left nasal blockage and epistaxis along with foul smelling brownish discharge for 1-day duration. Nasal endoscopic examination of the left side of the nose revealed an impacted button battery at the cartilaginous portion of the nasal septum.
A 68-year-old female presented with a 1-month history of lower back pain with right-sided radiculopathy and numbness. She was diagnosed with lumbar spondylosis and treated conservatively with analgesia and physiotherapy. Imaging showed multiple susuk, a metal alloy, in the lower back region and other regions of the body. The patient had undergone traditional medicine consultation 10 years earlier when the susuk was inserted in the lower back as talisman. The practice of the insertion of susuk is popular in rural East Malaysia and Indonesia. These foreign bodies act as possible causes of chronic inflammation and granuloma formation. In addition, the localised heighten peril upon imaging. This report suggests that the insertion of multiple susuk as talisman carries risk to safety of patients when imaging, and this practice complicates the management of musculoskeletal disorders.
Common foreign bodies in adults include fish bones and improperly chewed meat A 72-year-old Malay gentleman was brought in by his son to the emergency department after he was seen gasping at home. The patient has an underlying history of stroke with neurological deficit include his gag reflex. According to family members, the patient had the symptom a day after he had allegedly consumed a piece of durian without removing its seed. Patient was then admitted to Intensive care Unit (ICU) for monitoring. His blood gas normalized and was extubated after 2 days in ICU before discharged home the next day.