Widening of Narrowed Food pipe - Oesophagoscopy with dilatation


Swallowing difficulties may lead to inadequate intake of fluids and nutrients. There is also an increased risk of regurgitation or vomitus enters the lungs and cause aspiration pneumonia.

The esophageal dilation is designed to improve swallowing by widening a narrow segment of the esophagus (food tube). This procedure is performed through the mouth. The doctor may insert a rubber dilator to stretch the narrow segment of esophagus or break the stricture. Repeated dilation may be necessary to prevent the recurrence of the narrowing. Surgical replacement of the esophagus with a segment of the stomach or large intestine may be attempted in failed cases.

In most of the cases it will mechanical obstruction in the food pipe. So mechanical dilators are used it break the obstructions.
  • Simple Dilators: The bougie is the fastest and simplest method of opening the esophagus. They are series of flexible dilators of increasing thickness.
  • Guided Wire Bougie: The physical place the flexible wire using an endoscope. A dilator with a hole in it from end to end is guided down the esophagus and across the stricture. At the end of the procedure, the wire is removed. This may be performed in the x-ray department under Fluoroscopy.
  • Balloon Dilators: Flexible Endoscopy allows the physician to directly view the stricture. Deflated balloons are placed through the scope and across the stricture. This break the stricture when inflated.
  • Achalasia Dilators: Achalasia requires a larger, balloon-type dilator. The procedure is always done under x-ray control. The spastic muscle fibers in the lower esophagus are stretched and broken, which allows easier passage of food and liquid into the stomach.

Foreign body removal from Air way


The diagnosis and treatment of foreign bodies in the airway are a challenge for otolaryngologists. Most of the deaths occur before hospital evaluation and treatment. A high index of suspicion is needed for foreign body aspiration to allow for prompt treatment and avoidance of complications.

Foreign bodies in the ear:
Any object that is placed in the ear, nose, or mouth that could cause harm without immediate medical attention can be called a foreign body. Foreign bodies in the breathing tract may cause suffocation and death. Foreign bodies can also be found in either the ear lobe or in the ear canal, insects, toy pieces, buttons, pieces of crayon, small batteries or anything that can fit in the ear are the foreign bodies in the ear. Some objects inserted in to the ear remain asymptomatic, while others, such as food and insects, may cause pain in the ear, redness, or drainage. Hearing may be affected if the object blocks the ear canal.

Treatment:
Foreign body removal should be done by the doctor. He may use instruments which are inserted in the ear, magnets if the object is metal, cleaning the ear canal with water or a machine with suction to help pull the object out.

Foreign bodies in the airway:
Foreign bodies in the breathing tract are commonly seen in children. Objects in the nose are usually soft things. These would include tissue, clay, and pieces of toys, or erasers. Sometimes it may accidentally enter the nose when the child tries to smell that. Nasal drainage is the most common symptom of a foreign body in the nose. The drainage appears only on the side of the nose with the object and often has a bad odor and may also have a bloody nose. A foreign body in the airway should be considered as a medical emergency and requires immediate attention. The foreign body can get stuck in many different places within the airway.

Food may cause the obstruction of esophageal tract or airway in children who do not have a full set of teeth to chew completely. Children also do not have complete coordination of the mouth and tongue which may also lead to problems. Foreign body ingestion requires immediate medical attention. Each child may experience symptoms differently including; choking or gagging when the object is first inhaled, coughing and wheezing. Even if the initial symptoms subside, the foreign body may still be obstructing the airway. The child may experience cough that gets worse, child is unable to speak, pain in the throat area or chest, hoarse voice, blueness around the lips, breathing problem and become unconscious.

Treatment: Sedating the child is sometimes necessary in order to remove the object successfully. Conscious patients with acute choking should be encouraged to cough. No external instrument is necessary in such cases. Sometimes, surgery is necessary to remove the object. In the unconscious patient, endotracheal intubation should be performed immediately, unless the foreign body can be seen in the upper airway. Rigid bronchoscopy should be performed in cases of stridor, asphyxia. After removal of the object, physician may prescribe nose drops or antibiotic ointments to treat any possible infections.
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