The Use of Videolaryngoscopy for Managing Fish Bones and Other Foreign Bodies in the Throat within the Emergency Department

Managing Fish Bones and Other Foreign Bodies in the Throat

Abstract

Throat foreign bodies, mainly fish bones, are a common emergency department (ED) presentation in Thailand and conventionally require otolaryngology (ENT) consultation. The study aimed to evaluate the effectiveness and safety of videolaryngoscopy performed by emergency and general physicians for managing throat foreign bodies, compared with conventional management. This quasi-experimental study compared patients with suspected throat foreign body before (control, n = 27) and after (intervention, n = 22) implementing videolaryngoscopy (Insighters IS6, Macintosh blade size M or L) in the ED of Phichit Hospital. Primary outcomes were foreign body visualisation and successful removal. Visualizations and successful removal were significantly higher in the intervention group (72.7% vs 29.6%, p = 0.004; RD +43.1%, 95% CI 17.7 to 68.5; RR 2.45; OR 6.33; NNT 2.3). Median procedure time was 4.0 minutes with a median of 2 attempts. Topical anaesthesia (86.4% vs 11.1%), non-active bleeding (59.1% vs 21.1%) and antibiotic use (86.4% vs 40.7%) were more frequent in that group, whereas ENT referral was numerically lower (4.5% vs 18.5%). In conclusion, videolaryngoscopy improved foreign body detection and removal. Given the small sample, historical controls and increased minor mucosal bleeding, it should be regarded as an adjunct where ENT service is not immediately available, rather than routine ED practice