What should I do if I have a fish spike? A foreign body in the pharynx is a common emergency in otorhinolaryngology, and fish spike foreign body accounts for about 90% of the foreign bodies in the pharynx. The mucosal sensory nerves in the pharynx are rich and sensitive, so a very small foreign body can cause discomfort and stinging to the patient. In clinical practice, the patient can tell the type of fish spike stuck and point out the plane where the foreign body is located outside the neck, but many patients use vinegar to dissolve it and use vegetables and rice balls to swallow it (strong correction: these methods are undesirable and unscientific), resulting in the breakage of the exposed part of the fish spike, or the fish spike piercing into the tissue and entering the hidden place, which is not easy to find and remove. The patient’s medical history and symptoms should be inquired in detail. The examination should be careful and comprehensive, following the path of food entering the esophagus through the pharynx. First of all, according to the patient’s complaints, determine the possibility and location of foreign body retention and conduct targeted examination. If the patient has persistent stabbing pain in the pharynx, fixed location, and a scratching sensation when swallowing, there is a high possibility of foreign body. The general order of examination is oral cavity, oropharynx, with special attention to the tonsils, tongue root and soft palate, tongue epiglottis valley, pear-shaped fossa, and crevicular fissure, as these are common sites for fish spikes. For foreign bodies in the lateral wall of the pharynx, tonsils, and soft palate (commonly known as epiglottis or oropharyngeal foreign bodies), the foreign body and the exposed stump of the foreign body are usually found on the side where the patient confirms the presence of the foreign body, and can be removed with lance forceps; for patients with sensitive pharyngeal reflex, a small amount of local spray of cocaine can be used for anesthesia before clamping. If no foreign body or stump is found, and the patient still feels that it is in the epiglottis, then gun-like forceps (or vascular forceps) should be used to explore in the crypt and local area. Alternatively, gauze can be used to pull out the tip of the patient’s tongue, and the patient’s tongue root can be gently pressed with a tongue depressor to check for foreign bodies between the tonsils and the tongue root, and then observe the tonsillar sockets with the tip of the fish spike exposed by pulling the tip of the tongue and using an indirect laryngoscope to reach behind the tonsils to observe for foreign bodies between the tonsils and the pharyngeal palate. For the hypopharynx, that is, the laryngopharynx foreign body (such as the tongue epiglottis valley, pear-shaped fossa, crevicular fissure, etc.), the patient should be anesthetized with cocaine first, and then asked to pull the tongue out of the mouth, open the mouth wide and breathe calmly, and then hold the laryngoscope in the left hand and the foreign body clamp in the right hand to remove quickly. During the examination, salivary mucous filaments are often found, which can be easily mistaken for fish spikes, so the patient should be instructed to spit out or swallow them and then examine them carefully. If no foreign body is found during repeated examinations, and the patient has obvious foreign body sensation, fiberoptic laryngoscopy or barium swallowed from the esophagus should be performed. If a foreign body or foreign body wound is not found in the oropharynx or laryngopharynx, such as choking and coughing when a foreign body is stuck in the oropharynx, the nasopharynx should be carefully examined, and if a foreign body wound is found in the nasopharynx and no foreign body is seen, the corresponding part should be examined for the presence of foreign body. If the foreign body is still stinging after removal, the patient should be carefully examined for the presence of a second fish spike. If the patient complains of pain or foreign body sensation in the middle of the neck or even in the lower part and has obvious symptoms of dysphagia, and no foreign body is found in the oropharynx or laryngopharynx, the patient should be considered as a possible foreign body in the esophagus, and barium swallowing fluoroscopy should be performed. If the patient complains of a stuck pig bone, chicken bone or duck bone, the possibility of a foreign body in the esophagus is considered to be high, and these patients usually have a more painful expression. After repeated examination no foreign body is seen and still feel the stinging pain should take lateral cervical film and esophageal barium swallowing hanging cotton examination to ensure that no foreign body is found, can take anti-infective, anti-inflammatory or sedative drugs for conservative observation, generally such foreign body feeling symptoms in the later gradually disappear. If you still feel discomfort or increased pain, you should follow up promptly. In clinical work, according to incomplete statistics, about half of the patients complaining of foreign body in the pharynx visit, there is no foreign body residue, most of them are due to foreign body stuck in the mucous membrane of the throat and caused by sore throat and foreign body feeling, a small number of foreign body loose into the stomach on the way to the clinic. As mentioned above, if you have a fish spike or any other problem, go to the otorhinolaryngologist at first, and do not listen to what people say, such as drinking vinegar or swallowing rice balls, which may aggravate the damage to the throat or esophagus. But do not worry, in general, if the presence of foreign bodies is confirmed, they can be removed.