An Assessment of Management Strategies for Adult Patients with Foreign-Body Sensation in the Neck

Nidhi Garg; Ryan N Lee; Renee Pekmezaris; Sanjey Gupta

doi:10.4103/JETS.JETS_131_19

An Assessment of Management Strategies for Adult Patients with Foreign-Body Sensation in the Neck

J Emerg Trauma Shock. 2021 Jan-Mar;14(1):28-32. doi: 10.4103/JETS.JETS_131_19. Epub 2021 Mar 23.

Authors

Nidhi Garg¹, Ryan N Lee², Renee Pekmezaris³, Sanjey Gupta¹

Affiliations

¹ Department of Emergency Medicine, Southside Hospital, Bay Shore, New York, USA.
² Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York, USA.
³ Department of Medicine, Northwell Health, Manhasset, New York, USA.

Abstract

Objectives: Patients come to the emergency department (ED) for the evaluation of foreign-body sensation in the neck. Given the dearth of clinical studies for this complaint, these patients are treated subjectively by different providers. We aim to propose a treatment approach that results in the timely diagnosis and removal of foreign bodies by comparing the common radiologic studies used in the ED for this complaint, determining the utility of consults, and providing an approach that minimizes length of stay.

Methods: We conducted a retrospective cohort study of adults between January 2014 and December 2015 presenting to LIJ and NSUH EDs with a chief complaint of foreign-body sensation in the pharynx, larynx, or esophagus. Fifty unique cases were studied. Consultations with ear, nose, and throat (ENT) and/or gastrointestinal, any imaging studies used, and time until discharge from the hospital were the primary exposures studied. The time for each diagnostic path for successful removal of a foreign body was compared for each case.

Results: Three common diagnostic approaches were identified. The most common pathway (six cases) had an ENT consult for removal of the foreign body, with an average time to discharge of 188 min. Another common pathway (four cases) began with a neck X-ray followed by an ENT consult, with an average time of 327 min. The third common approach (6 cases) involved no imaging studies or consults, with an average time of 166 min. Neck X-ray (20 cases) was found to have a sensitivity of 43% and a specificity of 83%. The sensitivity of neck computed tomography (CT) (15 cases) had a sensitivity of 91% and a specificity of 50%. Chest X-ray (15 cases) was found to have a sensitivity of just 17%. Chest CT (3 cases) had a sensitivity of 67%.

Conclusion: Based on our data, we recommend that an attempt to localize the foreign body be completed by the emergency physician. If an initial attempt does not resolve the sensation, an ENT consult to remove the possible object should be initiated. Only after failure by ENT should radiological imaging be considered.

Keywords: Diagnostic management; foreign-body sensation in neck; foreign-body sensation in throat.