Foreign body in the nasopharynx; masquerading as pharyngotonsillitis

Abstract

Foreign body (FB) in the aerodigestive tracts has been commonly reported but findings of impacted foreign bodies in the nasopharynx following inhalation/ingestion are very rare. Most of the FB gets lodged as a result of forceful vomiting, coughing,and digital manoeuvres for removal of FB in the oropharynx. Several objects have been identified lodged in the nasopharynx.No age group is spared although most victims are children under 10 years of age.

Foreign bodies in the nasopharynx can be uneventful or potentially dangerous depending on type,size and location as it may cause sudden airway obstruction,or local pressure necrosis of alimentary or respiratory tract or both.

Presentation in children is usually with a history of swallowed FB which may not be witnessed in children, choking, cough, bluish discolouration, breathlessness, drooling of saliva, halitosis, rhinorrhoea, snoring, stridor, dysphagia, vomiting and dysphonia.

A foreign body in the nasopharynx is a challenge to patient, parents,the physician and the ENT surgeon,as it may be miss-diagnosed,in the index case,as Pharyngotonsilitis.

The index patient,a 14 month child,was presented with a two days history of fever,drooling of saliva,mouth breathing, and digital manipulation. Lateral imaging of the post nasal space following initial treatment with antibiotics, aided the diagnosis of a periwinkle shell in the nasopharyngx that was removed during a nasopharyngoscopy under general anaesthesia without complication and subsequently discharged home.

This emphasizes a high index of suspicion for FB in the nasopharynx in children with history of missing foreign body, digital manipulation, drooling of saliva and mouth breathing. Lateral X-ray of the postnasal space, neck, chest and abdomen should be the minimum investigation required.