Management of a Foreign Body in the Throat: Should Awareness of Channelled Flexible Nasendoscopes Be Encouraged Among Junior ENT Doctors?

Ingested foreign bodies in the upper aero-digestive tract are a common ENT emergency. Initial assessment and management by a junior ENT doctor involves removal of the foreign body under direct visualisation, with escalation to removal under general anaesthesia (GA) if unsuccessful. However, removal under general GA carries procedural risks, anaesthetic risks, and a higher cost profile. An adult female presented to our unit with a fish bone lodged in the right pyriform fossa. Initial removal with instruments and direct visualisation with a flexible nasendoscope (without a working channel) was attempted but was unsuccessful. She was scheduled for removal under GA. At morning handover, an alternative approach was suggested (a method not routinely familiar to the on-call junior doctor team) and trialled using a single-use flexible nasendoscope with a working channel. Following topical anaesthesia, the scope was passed orally, and biopsy forceps were introduced via the accessory channel, which allowed for the successful removal of the fish bone. The patient was discharged the same day without complications, avoiding admission and GA. She was followed up with a telephone call and reported that she had returned to her normal routine with no significant complications. While not a novel treatment plan, flexible nasendoscopes with working channels represent a valuable adjunct in escalation protocols for foreign body retrieval. Their use can reduce the need for GA, prevent unnecessary admissions, and optimise resource use in selected cases. Education and training for these instruments can be considered or encouraged among junior ENT doctors to avoid unnecessary admissions for these presentations. However, broad conclusions should not be extrapolated from a single case study, and further audits and surveys of junior doctors' knowledge and expertise are required.