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Factors associated with the true location of ingested fishbones

Lu, Yen-Tinga,c,d; Chen, Hung-Wenb; Tseng, Yao-Yinga; Chen, Chia-Hsib; Lu, Ying-Choua

European Journal of Emergency Medicine: June 2019 - Volume 26 - Issue 3 - p 224–227
doi: 10.1097/MEJ.0000000000000527
Original articles

Objectives Fishbone ingestion is a common problem worldwide, and the first step for managing this condition is to locate the fishbone precisely. However, until now, no study has analysed the true location of fishbone and its associated factors. Thus, this study identified the factors predicting the true location of fishbone and subsequently attempted to provide a management algorithm for fishbone ingestion.

Patients and methods This retrospective study was carried out at St Martin De Porres Hospital, Taiwan, between January 2015 and January 2016. All patients were diagnosed as having fishbone ingestion within the pharynx and underwent fishbone removal.

Results This study included 198 consecutive patients with a mean age of 43.1 years (range: 1–84 years). The sensitivity of lateral neck radiography in the diagnosis of fishbone in the pharynx was only 22%. The fishbone locations were as follows: the tonsil in 72 (36.4%) patients, the tongue base / vallecula in 112 (56.6%) and the hypopharynx in 14 (7.0%). Multiple logistic regression analysis showed that patient age and fishbone length were significant independent risk factors associated with the true location of fishbone ingestion. Among all patients, fishbone was removed transorally under direct vision in 73 (36.9%) patients and using flexible nasopharyngoscopy in 125 (63.1%) patients.

Conclusion Patient age and fishbone length are important independent factors associated with the location of ingested fishbone. Lateral neck radiography is not beneficial for diagnosing fishbone ingestion within the pharynx. Flexible nasopharyngoscopy, by contrast, is an important method for the diagnosis and treatment of fishbone ingestion within this location.

Departments of aOtolaryngology

bEmergency Medicine, St Martin De Porres Hospital, Chiayi

cSchool of Medicine, Chung Shan Medical University

dDepartment of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan (Republic of China)

Received 13 August 2017 Accepted 19 November 2017

Correspondence to Ying-Chou Lu, MD, Department of Otolaryngology, St Martin De Porres Hospital, No. 565, Sec. 2, Daya Road, Chiayi 11217, Taiwan (Republic of China), Tel: +886 5 2756000; fax: +886 5 2762905; e-mail:

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