The present study is a hospital based retrospective study conducted in the Department of Otorhinolaryngology in association with Department of Anaesthesiology and Critical Care in a tertiary care centre from North Eastern India. Study includes patients admitted for ENT FB from year 2009 to 2014.

Patients of all ages admitted with history of ENT FB that required GA for its removal. Those patients with no history of FB but where FB was retrieved during surgery were also included.

Patients with history of suspected FB but where no FB was found after examination under GA were excluded.

Data was collected from indoor patient record file and operation record book and anaesthesia management chart. Information were collected for the following parameter: Patient’s age and sex, location of FB, types of FB, history of prior instrumentation, presenting complaints, investigation finding, complications related to FB, complications due to GA or operative procedure.

Data was assembled in Microsoft Excel spread sheet for analysis and p-value of less than 0.05 was taken as significant.

During the study period from 2009 to 2014, 113 numbers of patients were admitted with history of ENT FB for removal under GA and out of 113 patients, four were excluded as nothing was found after examination under GA. In three patients admitted with diseases of ear and nose, FB was found during mastoidectomy and endoscopic sinus surgery. So, for our study total 112 patients were selected of which, 69(61.6%) and 43(38.4%) were male and female respectively. Male to female ratio was 1.6. In our study the youngest patient was 11-month-old and the oldest was 74-year-old with mean age of 13.6 years. Paediatric (up to 18 years of age) and adult patients represented 85(75.9%) and 27(24.1%) respectively. Majority (68.7%) of patients belonged to the 0-10 years age group as shown in [Table/Fig-1]. Food passage (58.9%) was the most common site followed by ear (21.4%), tracheobronchial tree (8.9%), nose (8%) and soft tissue of head and neck (2.7%). Distribution of FB in different anatomical location is shown in [Table/Fig-2]. [Table/Fig-3] showed the distribution of different types of FB in different anatomical location. Distribution of different types of FB along with location in different age groups is shown in [Table/Fig-4a,b,c]. In our study FB were divided into animate and inanimate. Animate and inanimate were present in 2(1.8%) and 110(98.2%) patients respectively. Out of 110 inanimate FB, 36(32.8%) were organic and 74(67.2%) were inorganic. Laterality was calculated for FB located in ear and nose. It was found on right, left and bilateral in 24(72.8%), 8(24.2%), 1(3%) respectively. The frequency of FBs in the right side of ear and nose is significantly higher than the left side (p < 0.05). Factors like time lapse at presentation, history of previous instrumentation and complications related to FB removal is shown in [Table/Fig-5].

As Otorhinolaryngologists deal with maximum number of natural orifices of body that are habitually exposed, so is the high rate of encountering FB as emergency cases. Individual from infancy to elderly may present with ENT FB, but the frequency, anatomical distribution and types of FBs differs between extremities of ages. Male predominance was seen in our study similar to study by Shrestha I et al., [5]. As our study includes only those cases where GA was required for FBs removal, the distribution pattern of ENT FBs is different from other studies [5,6]. Generally most of the ENT FBs are located in ear and nose and majority of them can be easily removed without any complication as reported in different studies [3–5,7]. Ear and nose FBs are more common in right than left side as reported by previous studies, similar finding was observed in present study [8]. Otolaryngology FB is most prevalent in paediatric age group, especially in small children below 5 years [6,9,10]. In our study majority (68.7%) of patients were below 10 years of age. This may be due to gradual development of milestones, application of five senses, increased inquisitiveness, habit of playing and eating at same time and sometimes due to negligence of guardians.

FB may be classified into animate and inanimate. Inanimate FB may be organic and inorganic. In our study majority (98.2%) of FB were inanimate with predominance of inorganic objects (60.7%) in all anatomical sites except nose. Among organic FB, meat bone (44.4%) were commonest followed by pulses and seeds (27.8%). Coin (51.4%) ranked highest among inorganic FB followed by plastic beads and toys in 16.2% of cases. This pattern of type of FB is due to selection criteria of our study and because of predominance of FB in food passage. Our observation on types of FB in different anatomical sites varies from other studies [1–3]. It may be due to difference in profile of patients and local customs in different regions [11].

Majority of FB in present study were located in food passage in both paediatric and adult age groups, which represented 50.6% and 82.7% respectively in each age group. Other sites in decreasing order of frequency in paediatric age group were ear (25.3%), tracheobronchial tree (12%), nose (9.6%) and soft tissue of head and neck region (2.4%). While in adults other anatomical sites involved were ear (10.3%), nose (3.4%) and soft tissue (3.4%). Our findings reflect pattern of FB requiring GA for removal and varies from most studies [1,2,4], as both in patients and out patients were included in their study and moreover most FB of ear and nose can be removed as outpatient department procedures without need of GA [12].

In our study FBs of ear and nose showed marked similarity in age distribution, types of FB and time of presentation. Most of the patients with FB ear and nose were children less than ten years of age. But type of FB and presentation of patients differed between young and old. In children, FB of ear, nose were related to food items, toys, stationery goods and others and all of them gave history of FB insertion [6,13]. FB of nose is very uncommon in adults. In our study, FB of ear and nose in adults was discovered while doing other surgeries (mastoidectomy for chronic otitis media and endoscopic sinus surgery for chronic sinusitis) and majority did not have any preoperative history of FB and it was found to be either wooden stick or cotton for cleaning ear and nose [14]. Generally inert FB may remain for years without producing any symptoms but organic FB like cotton, wooden stick as in our study induces inflammation and sometimes may cause complications like sinusitis, otitis media and tetanus [14–16].

Unlike the pattern of distribution in ear and nose, FB of food passage was found across all age groups. Coin was most commonly encountered in children and meat bone was seen in majority of adults. Majority of them were located in cervical oesophagus and were removed without any complications [17,18].

Most of the tracheobronchial tree FBs were inorganic unlike findings of other studies [3,19]. We have witnessed certain unusual inorganic FB like broken tracheostomy tube and torch bulb [20]. FBs tracheobronchial tree in most of the cases were removed with rigid bronchoscope but two patients required open thoracotomy due to inaccessible location of the FBs in terminal bronchiole.

In our study only FB of food passage presented early within 24 hours. This may be due to the pain and difficulty in swallowing. But FB of other sites presented late due to delayed onset of symptoms, negligence by guardians, painless clinical picture and remote location of villages [19].

The reason for requirement of GA for removal of FBs in ear and nose was either due to spherical or cylindrical shape, impacted and deep seated location, small age, uncooperative patients or previous attempt of removal. As previous history of instrumentation was present in ear and nose in 62.5% and 66.6% cases respectively, GA was required in these cases for proper visualisation, atraumatic removal and to avoid further complications related to instrumentation. In our study, ear FB were removed under microscope without any major complications except in one case where FB (bead) perforated the tympanic membrane and was seen to be lodged in the middle ear which was eventually removed by post-auricular approach.

Foreign bodies of ENT that require GA for removal is encountered in all age group with majority in the small children less than 10-year-old. Majority of the cases had FB in the food passage followed by ear, nose and tracheobronchial tree. In children common FB are either play things or food items while in adult most are food materials. Ear and nose FB that needed GA for removal is mostly due to uncooperative nature of the patients, prior instrumentation, spherical shape of FB, or impacted and deep seated location. Tracheobronchial or food passage FB depending upon the shape and location of FB may require open thoracotomy for removal with major complications.