A 70-degree telescope used in diagnosing fish bone in the upper aerodigestive tract

Abstract

Objectives: Fish bones are the most common foreign bodies found in the upper aerodigestive tract in adults and require immediate treatment. Many techniques have been developed for diagnosing difficult fish bone cases. A 70-degree telescope has many advantages and has been used for laryngopharyngeal examination in difficult or reactive gag-reflex cases at our clinic for many years. We therefore tested the utility of a 70-degree telescope in the diagnosis and removal of fish bones retained in the upper aerodigestive tract. Methods: Seventy-eight patients who received treatment for fish bone impaction in the upper aerodigestive tract were enrolled in the study. All patients were examined using a laryngeal mirror and the material was removed in visible cases. Negative finding from the laryngeal mirror were re-examined using a 70-degree telescope. Negative finding from the telescope were recommended for endoscopy under GA. Results: Diagnosis was successful by laryngeal mirror examination in 52/78 cases (66.7%). The remaining 26 cases were re-examined with a 70-degree telescope, and fish bones were detected in 22 cases(84.6%), mainly located at the inferior tonsil and valleculae. Of the 4 cases that failed telescopy, endoscopy under GA found fish bones embedded in the inferior tonsil (1/4), at the postcricoid area (2/4), and at the posterior pharyngeal wall (1/4). Conclusion: A 70-degree telescope is very beneficial for diagnosing and removing impacted fish bones, especially at the tongue base, inferior tonsil, valleculae, and supraglottic area. It is very useful in reducing the risk and cost of GA, and is recommended as an alternative procedure when fish bone retention of the upper aerodigestive tract is suspected.