DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20210690

Auscultating a pea: the stethoscope may matter in otorhinolaryngology emergency evaluation

Francisco Alves De Sousa, Ana Costa Silva, Ana Nóbrega Pinto, Cecília Almeida E. Sousa

Abstract


Foreign body sensation is a common complaint in the otorhinolaryngology emergency. Careful examination of the patient’s pharynx is mandatory, but sometimes the object is not visualized. In such scenario, it may be important to explore signs and symptoms indicating lower aerodigestive impaction. This work describes the case of a 73-year-old woman without relevant comorbidities attending to emergency care. She complained of a foreign body sensation on the right side of the throat after ingesting a meal, which motivated referral to otorhinolaryngology. Flexible transnasal nasopharyngoscopy was unremarkable and no foreign bodies were found. Auscultation was performed revealing low-pitch expiratory wheezing on her right hemithorax. The suspicion of bronchial foreign body was then raised, which was ultimately confirmed by imaging and bronchoscopy, showing an impacted pea on the right lower lobe bronchus. The stethoscope was hence determinant for detecting aspiration, by revealing consistent alterations. Its usage should be encouraged in similar scenarios, highlighting the role of this classic but sometimes forgotten tool. Importantly, higher neck/throat sensations should not exclude the possibility of a lower airway foreign body.


Keywords


Stethoscope, Foreign body, Aspiration, Throat sensation

Full Text:

PDF

References


Mathew P, Tiwari R, David J, Tiwari H. MEDICAL Short Review A Review on Foreign Body Obstruction in Throat and A Case of Molar Tooth in Esophagus. 2016;3(3):469-71.

Arabi Mianroodi A, Teimouri Y, Vallance NA. Foreign bodies: aspirated or ingested? A report of two unusual cases. Iran J Otorhinolaryngol. 2012;24(67):91-4.

David L, Dumitrascu DL. The bicentennial of the stethoscope: a reappraisal. Clujul Med. 2017;90(3):361-3.

Connolly AA, Birchall M, Walsh-Waring GP, Moore-Gillon V. Ingested foreign bodies: patient-guided localization is a useful clinical tool. Clin Otolaryngol Allied Sci. 1992;17(6):520-4.

Lee L-Y. Respiratory sensations evoked by activation of bronchopulmonary C-fibers. Respir Physiol Neurobiol. 2009;167(1):26-35.

Mazzone SB. An overview of the sensory receptors regulating cough. Cough. 2005;1:2.

Undem BJ, Kollarik M. The role of vagal afferent nerves in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2005;2(4):355-72.

Afghani R. Unusual aspiration of foreign body in adults. Ann Cardiovasc Thorac Surg. 2018;01(01):8-10.

Bain A, Barthos A, Hoffstein V, Batt J. Foreign-body aspiration in the adult: presentation and management. Can Respir J. 2013;20(6):e98-9.