Fish bone “stuck in the throat”? You may not have to ship this off to ENT after all.

A 23-year-old male presents to the Emergency Department (ED) with 4 days of a persistent sensation of a ‘fish bone’ stuck in his throat. Patient ate fish tacos 4 nights prior to arrival. The patient describes feeling a sharp foreign body stuck along the right side of his upper throat, just proximal to the angle of his mandible. The pain is worse with swallowing, and turning his head to the right.

The patient denies any shortness of breath, dysphagia, no drooling, no stridor, no fevers or chills, and no vomiting.

On physical exam, the patient has normal vital signs, appears comfortable, is not drooling and has no audible stridor. The patient has no crepitus along the right lateral neck, and there is no palpable mass or foreign body.  The patient has a Mallampati Class I and the tip of his epiglottis is visible, without edema, no bleeding, and no visible foreign body.  A mouth mirror fails to provide adequate visualization to identify the foreign body.

When asked where the patient can feel the foreign body, he points to his lateral right neck at approximately the level of the right tonsillar crypt, just above the hyoid bone.   

A Soft Tissue Lateral Neck X-ray was completed (below):

See NEXT page for a step-by-step run-down of how to handle this complaint using direct laryngoscopy.