Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, People's Republic of China, Xuhui District, Shanghai.
Department of Otolaryngology-Head and Neck Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China, Shanghai.
Ear Nose Throat J. 2024 Mar;103(3):168-172. doi: 10.1177/01455613211036770. Epub 2021 Sep 7.
Accidental pharyngeal fishbone ingestion is a common complaint in ear, nose, and throat clinics. Approximately two-thirds of the accidentally ingested fishbones can be removed using tongue depressors and indirect laryngoscopy. However, the remaining third is challenging to identify and remove using these methods. These difficult fishbones require identification and removal via more advanced approaches. Video-guided laryngoscope is used to deal with difficult fishbones in our center. This study aimed to explore the risk factors for difficult fishbones.
A prospective study was performed at a teaching hospital on 2080 patients. Univariate and multivariate analyses were performed to identify the risk factors.
The common fishbone locations were the tonsils (39.8%; defined as STEP-I), tongue base (37.1%), vallecula (13.3%; STEP-II), and hypopharynx (9.8%; STEP-III). With increasing STEP level, the ratio of difficult fishbones correspondingly increased (Z = 13.919, < .001), and the proportions were 21.1%, 41.9%, and 70% in STEP-I, II, and III, respectively. In particular, fishbones in STEP-III (vs STEP-I) had a higher risk of difficult fishbones (odds ratio [OR]: 11.573, 95% CI: 7.987-16.769). Complaints of neck pain (yes vs no), foreign body sensation (yes vs no), and shorter length of fishbones always had a lower risk of difficult fishbones (OR: 0.455, 95% CI: 0.367-0.564; OR: 0.284, 95% CI: 0.191-0.422; OR: 0.727, 95% CI: 0.622-0.85). Missing teeth (yes vs no), swallowing behavior after fishbone ingestion (yes vs no), and male patients (vs female) had a higher risk of difficult fishbones (OR: 1.9, 95% CI: 1.47-2.456; OR: 1.631, 95% CI: 1.293-2.059; OR: 1.278, 95% CI: 1.047-1.56).
Neck pain, foreign body sensation, fishbone length, patient age and sex, tooth status, and swallowing behavior after fishbone ingestion are independent risk factors for difficult fishbones.
咽喉鱼刺异物是耳鼻喉科的常见就诊原因。大约三分之二的意外吞食鱼刺可以通过压舌板和间接喉镜取出。然而，其余的三分之一则难以用这些方法识别和取出。这些困难的鱼刺需要通过更先进的方法来识别和取出。在我们中心，使用视频喉镜来处理困难的鱼刺。本研究旨在探讨困难鱼刺的危险因素。
在一家教学医院进行了一项前瞻性研究，共纳入 2080 例患者。采用单因素和多因素分析来识别危险因素。
常见的鱼刺位置是扁桃体（39.8%；定义为 STEP-I）、舌根（37.1%）、会厌谷（13.3%；STEP-II）和下咽（9.8%；STEP-III）。随着 STEP 水平的增加，困难鱼刺的比例相应增加（Z = 13.919，<.001），分别为 21.1%、41.9%和 70%。特别是，STEP-III 中的鱼刺（与 STEP-I 相比）更有可能是困难鱼刺（比值比[OR]：11.573，95%置信区间[CI]：7.987-16.769）。有颈部疼痛（是 vs 否）、异物感（是 vs 否）和鱼刺较短的患者，其发生困难鱼刺的风险较低（OR：0.455，95%CI：0.367-0.564；OR：0.284，95%CI：0.191-0.422；OR：0.727，95%CI：0.622-0.85）。有缺牙（是 vs 否）、鱼刺吞食后有吞咽行为（是 vs 否）和男性患者（与女性相比）发生困难鱼刺的风险较高（OR：1.9，95%CI：1.47-2.456；OR：1.631，95%CI：1.293-2.059；OR：1.278，95%CI：1.047-1.56）。
颈部疼痛、异物感、鱼刺长度、患者年龄和性别、牙齿状况以及鱼刺吞食后的吞咽行为是困难鱼刺的独立危险因素。
