Impacted Fish Bones: A National Survey

Area of Science:

• Otolaryngology
• Medical Education
• Diagnostic Imaging

Background:

• Fish bone foreign bodies are a frequent cause for ear, nose, and throat (ENT) consultations.
• Diagnosis can be challenging due to limitations of standard investigations like lateral neck X-rays and flexible nasendoscopy (FNE).
• Management is often complex, with potential for serious complications.

Purpose of the Study:

• To evaluate UK ENT clinicians' awareness of current ENT UK guidelines for fish bone foreign bodies.
• To investigate current practice patterns in diagnosing and managing these cases.
• To identify specific knowledge gaps concerning symptoms, imaging, and anatomical locations.

Main Methods:

• A cross-sectional survey was conducted across UK ENT departments.
• Fifty-three participants, including consultants and trainees, completed the survey.
• The survey assessed awareness of guidelines, confidence, investigation preferences, and knowledge of fish bone characteristics.

Main Results:

• A significant majority (91%) of clinicians were unaware of existing fish bone management guidelines.
• Knowledge regarding the radio-opaque or radiolucent nature of fish species was variable.
• Commonly reported symptoms included odynophagia and dysphagia, with impaction often occurring at the palatine tonsils or tongue base.

Conclusions:

• There is considerable variability in the awareness, investigation, and management of fish bone foreign bodies among UK ENT clinicians.
• A need exists for updated guidelines and targeted educational initiatives to improve clinical confidence and standardize care.
• Enhanced education and clear guidelines can reduce unnecessary investigations and improve patient outcomes.