When solidly impacted, the foreign body may have to be crushed by means of a pair of solid forceps or drilled or sawed through. These operations are dangerous, however, unless performed by an expert rhinologist. The foreign body may sometimes be pushed back into the naso-pharynx and removed with the post-nasal forceps, but care must be taken not to lacerate the Eustachian promontory.
Foreign Bodies in the Pharynx.—This subject has been in part reviewed in the article on the (ESOPHAGUS (volume v), the majority of foreign bodies which enter the pharynx being, in reality, im pacted in the upper portion of the former, either behind the larynx or on either side of the latter, in one of the pyriform sinuses, or above the epiglottis. When, therefore, foreign bodies of the pharynx are spoken of and the limits of this cavity are properly established. the scope of the subject becomes restricted. In deed, unless it be a sharp object capable of sufficiently lacerating the upright pos terior pharyngeal wall to hold on to it, a foreign body will either pass below to the oesophagus as stated, or into the larynx, or lodge behind one of the pillars or into the tonsils. Strictly speaking, the latter are the seat of almost all foreign bodies which can be said to have become im pacted in the pharynx. These are almost always sharp objects, fish-bones, tacks, pins, etc.,—eapable of easily penetrating the tonsillar crypts or between the pil lars, or in the recess behind the posterior pillar.
Foreign bodies are often referred to as still present in the pharynx when, in reality, they have passed downward. This is usually due to the presence of a minute abrasion or scratch produced by the foreign body on its way downward. Again, hysterical subjects seem to present a predilection for pharyngeal foreign bodies, and in the majority of cases of this kind a foreign body has not been swallowed at all.
Foreign Bodies in the Larynx.—The foreign bodies that may become engaged in the larynx may be said to represent almost anything that may be introduced into the mouth. A large mass of meat totally beyond the dimensions of the cavity may clip one of its extremities into the latter, and cause fatal dyspnoea by acting as a stopper, or it may become jammed between the pharyngeal wall and the end of the epiglottis, and thus also cause immediate asphyxia. Tooth-plates, among the larger objects, are also fre quent intruders in this region. Those
which most frequently become lodged there, however, are principally articles of diet,—bones, bread-crusts, fish-bones, etc.,—which are drawn into the air-pas sages during a fit of laughter, just as the act of deglutition is being performed. Their penetration into the air-tract de pends greatly upon their size, small ob jects being frequently drawn into the trachea, while large objects remain in the upper part of the cavity.
Symptoms. — Immediate and violent retching, or coughing if the passage is not entirely occluded, follows entrance into the larynx of any object: a reflex act calculated to dislodge it. Sometimes this succeeds, the foreign body is coughed up and out, and the patient recovers at once, although his throat may remain painful for several days. When the for eign body is large enough to fill the laryn geal cavity sufficiently to occlude it, and the first expulsory effort does not suc ceed, the patient, having comparatively emptied his lungs of air, finds it impos sible to inhale; he makes desperate ef forts to draw air into his lungs, each effort causing the offending object to im pact itself more tightly in the glottis. In the great majority of cases, however, the object is of such a shape and form that sufficient air is permitted to enter the lungs to keep the patient alive. In this case, the first paroxysm, although severe, subsides; violent paroxysms of coughing follow, and, after a few min utes, comparative comfort is enjoyed until another coughing spell brings on dyspncea and a renewal of the first symp toms. After a time, the larynx seems to become accustomed to its new occupant, and a small object may even be forgotten and ejected in a fit of sneezing or cough ing long after. In many cases, however, such is not the case, and organic lesions may he caused which may endanger the patient's life. The inflammation occa sionally extends to the lungs, and a fatal result may be caused by pneumonia. Again, notwithstanding the spontaneous expulsion of a foreign body, secondary inflammation may follow and endanger the patient by oedema of the larynx. Tinder such circumstances, the patient at once experiences the preliminary stages of asphyxia; he gasps for breath and un less assistance be at once provided may die in a few moments. This is only apt to occur, however, when a mass totally occluding the larynx, such as a piece of dough or meat, becomes impacted.