The media reported the news that “a young man with a fish spike stuck in his throat punched a doctor when he heard that he had to use a laryngoscope to find the fish spike”.
Not long after, another report said that a patient was stuck with a 5 cm fish spike, not coincidentally next to the aorta, and the cost of the 6-hour operation was more than $100,000. Netizens have expressed their disbelief.
As an otolaryngologist, it makes my chest tight whenever I hear about a fight with a fish spike.
In fact, not only fish spikes can be stuck in the throat.
Date pits, coins, and all kinds of bones can get stuck in the throat and are frequent visitors to ENT emergencies, but fish spines are really the most common.
Where do fish spikes usually get stuck?
The word “stuck in the throat” is often used to describe something that is very disturbing, which means that a fish spike stuck in the throat is really uncomfortable. The exact location of the fish spike in the throat and the patient’s ability to cooperate with the doctor by keeping the mouth open will determine how the fish spike is eventually removed.
The most common location for a fish spike is in the oropharynx.
For example, in the picture below, this is the area that you can see when you open your mouth and look in the mirror. The circled areas, namely the tonsils and their surroundings and the root of the tongue, are all prone to fish spikes.
The most common and superficial sites for fish spikes are shown below, including the tonsils, the tonsil periphery, and the superficial part of the tongue. Once a fish spike is stuck, the patient can try to look for it in a mirror or with the help of a friend or relative in these areas. If it is still not found and the stinging pain is obvious, it is recommended to seek medical help.
Locations where fish spikes tend to get stuck, including in and around the tonsils and the root of the tongue
Going deeper, fish spikes can also get stuck in the laryngopharynx. Fish spikes in this area are usually difficult for patients to see on their own and need to be treated in the hospital. If you forcefully swallow a meal at this point, you risk pushing the foreign body into the esophagus.
There are four strictures in the esophagus, and the fish spike is most likely to get stuck at the first stricture, the entrance to the esophagus. If you swallow forcibly at this point, the foreign body may recede to the level of the second stricture, the aortic arch, or even penetrate directly into the aorta, which could be life-threatening.
What can I do at home if I have a fish spike?
More than 20,000 netizens voted and over 90% of them chose to try swallowing rice balls and drinking vinegar at home.
This result is not unexpected, but the possible consequences are alarming. For example, life-threatening fish spikes piercing arteries, fish spikes penetrating the esophagus causing esophageal perforation and mediastinal infection ……
So, what is the correct practice?
1.Don’t swallow rice
Don’t try to swallow a fish spike with a rice ball bun, because it will push a very shallowly positioned spike to a very deep level.
Even if you have ever gotten lucky and swallowed a fish spike and gotten through it, you must know that many partners have not been so lucky. A fish spike in the oropharynx can be pushed deeper into the throat or even into the esophagus because of swallowing rice, and a fish spike that was shallowly lodged can penetrate deep into the flesh because of swallowing rice.
The deeper the location, the harder it is for the doctor to find, and if it reaches the esophagus, it needs to be taken by gastroscopy or esophagoscopy.
2. Try coughing
If the fish spine is not too big, you can try to cough hard, and many times, those tiny fish spines will come off with the airflow.
3. Consult a doctor promptly for painful stings
If the fish spike is very large and hard, or if you feel a sharp stabbing pain in your neck or chest, it is recommended that you seek medical attention immediately.
What do doctors do with fish spikes?
In case the stinger does not come out, it is recommended to go to the hospital as soon as possible.
Depending on the size, depth and location of the fish spike, the doctor will treat it differently.
Direct retrieval: for fish spines that are visible to the doctor in the outpatient clinic and located in a relatively superficial location in the oropharynx or laryngopharynx, the doctor will first try to retrieve them under direct vision.
laryngoscopic retrieval: if the spike is too small and not found, or if the location is too deep, or if the patient has a gag reflex, that is, a particularly pronounced feeling of nausea and vomiting, the laryngoscope will be considered to remove the foreign body.
Gastroscopy or esophagoscopy: if the foreign body is suspected to have entered the esophagus, a “barium esophagus” examination will be done first; once confirmed, the foreign body will be removed by gastroscopy or esophagoscopy depending on the specific situation, which may require going into the operating room under general anesthesia.
CT examination: If no foreign body is found, but the patient feels sore throat or chest pain, or the neck is swollen, a CT of the neck or chest may be taken.
Open-chest surgery: If the foreign body is suspected to have penetrated the pharynx or esophagus, then the patient will have to go into the operating room and may need to invite a thoracic surgeon to perform open-chest surgery together.
A few misconceptions about stuck fish spines
1. Why do some people who have a fish spike get stuck fine, while others need a laryngoscopy, and some people who have a laryngoscopy need surgery?
Because the location of the card is different.
In addition to the shallow fish spikes mentioned above, which the doctor can find and remove under direct vision, some fish spikes get stuck in the “gullet” of the throat, and some patients have a pronounced “gag reflex” and feel nauseous and uncomfortable at the slightest touch, so the doctor cannot use his fist in the confined space.
Many patients are nervous when they hear about laryngoscopy, thinking that it will be as painful as gastroscopy.
In fact, the laryngoscope is just a tool to help the doctor find the fish spike. The laryngoscope, with its own light source and image magnification system, can make most of the fish spikes stuck in the pharynx visible, allowing the doctor to find and remove them without any problems.
However, there are still very few that cannot be found even under the laryngoscope. At this point the doctor may consider.
That the patient’s sensation is due to a localized abrasion of the spike, which has been dislodged.
that the fish spike has lodged in the skin and is indeed invisible
the fish spike has gone deeper, such as the esophagus.
2. Does it feel like there is something in the throat, must there still be a fish spike?
Not necessarily. If there is only a foreign body sensation without obvious stinging pain and it does not affect swallowing, either the fish spike is relatively small or it is bruised but has fallen out.
In this case, the doctor will usually advise the patient to observe it first after examination. If the pain or foreign body symptoms are aggravated, the patient will be seen again in time for laryngoscopy or other tests as appropriate.
3. Is it really life-threatening to get a fish spike stuck?
This is rare, but it does happen.
Two common possibilities are
The foreign body is sharp and hard, such as a large fish spike or chicken bone, which penetrates the pharynx or esophagus and punctures the large blood vessels, which may cause life-threatening hemorrhage at any time, like the second report mentioned at the beginning of the article.
The foreign body is not removed and, after some time, causes extensive and severe infection in the throat.
Both of these cases require surgical treatment now.
4. Can children eat fish?
You should try to avoid giving children fish with spines.
Children are not able to spit out the spines because their oral sensory development and cognition are not yet complete, so it is easy to get stuck.
Once a fish spike is stuck, the child may not be able to express himself clearly and may have difficulty going to the hospital for examination, which may cause inconvenience and increase the child’s pain.
If the fish spike is deep in the larynx, a special laryngoscope may be needed to remove it.
Therefore, it is recommended that young children eat fish with clean spines, or choose to eat fish without spines.
Fish is good, tasty and nutritious. But we still hope that everyone should concentrate on eating it and try to pick out the spines before eating.
Don’t swallow the bun again!