Publication:

Auscultating a pea: the stethoscope may matter in otorhinolaryngology emergency evaluation

Foreign body sensation is a common complaint in the otorhinolaryngology emergency. Careful examination of the patient’s pharynx is mandatory, but sometimes the object is not visualized. In such scenario, it may be important to explore signs and symptoms indicating lower aerodigestive impaction. This work describes the case of a 73-year-old woman without relevant comorbidities attending to emergency care. She complained of a foreign body sensation on the right side of the throat after ingesting a meal, which motivated referral to otorhinolaryngology. Flexible transnasal nasopharyngoscopy was unremarkable and no foreign bodies were found. Auscultation was performed revealing low-pitch expiratory wheezing on her right hemithorax. The suspicion of bronchial foreign body was then raised, which was ultimately confirmed by imaging and bronchoscopy, showing an impacted pea on the right lower lobe bronchus. The stethoscope was hence determinant for detecting aspiration, by revealing consistent alterations. Its usage should be encouraged in similar scenarios, highlighting the role of this classic but sometimes forgotten tool. Importantly, higher neck/throat sensations should not exclude the possibility of a lower airway foreign body.