Awake Forceps Retrieval of Complex Pharyngeal Fish Bone Impactions Using a Single-Use Nasendoscope With an Instrument...

Area of Science:

• Otolaryngology
• Medical Devices
• Health Economics

Background:

• Pharyngeal fish bone impaction is a frequent ENT emergency.
• While peroral removal is common, complex cases necessitate general anaesthesia (GA).
• Reusable nasendoscopes for guided removal have limited adoption due to decontamination needs.

Purpose of the Study:

• To evaluate the clinical effectiveness of awake, single-use channelled nasendoscope-guided fish bone retrieval.
• To assess the economic impact of this technique compared to GA removal.
• To determine if single-use nasendoscopes can increase the adoption of this minimally invasive procedure.

Main Methods:

• Retrospective case series of adult patients with fish bone impaction unsuitable for peroral extraction.
• Awake retrieval using single-use channelled nasendoscopes and flexible forceps.
• Analysis of success rates, complications, GA requirements, and costs based on NHS tariffs.

Main Results:

• 80% (8/10) of cases were successfully treated with awake nasendoscopic retrieval, with no complications.
• GA removal was required for 2 patients.
• The awake technique cost £202 per case versus £3,922 for GA, a saving of £3,720 per successful case.

Conclusions:

• Awake, single-use nasendoscope-guided fish bone removal is a safe and effective procedure.
• This method is substantially more cost-effective than GA removal.
• Wider adoption can decrease theatre demand, anaesthetic exposure, and healthcare costs.