Swallowed a fish bone? This is how it is removed by an ENT Specialist

With Chinese New Year just around the corner and with fish being an auspicious food,  many Singaporeans will be having more fish meals in the coming weeks. However, Dr Gan, an ENT Specialist in Singapore, warned that one better be extra careful when enjoying one of the fish meals!

Dr Gan was recently called to see a patient, Mr A, around midnight at the Accident & Emergency (A&E) at Mount Elizabeth Novena Hospital. The patient was a 56 year old Chinese gentleman who had just accidentally swallowed a fish bone while enjoying his fish-head curry supper. He subsequently complained of piercing pain in his throat which was worse on swallowing.

On examination, a nasoendoscopy (scope through the nose and down to the back of the throat) showed a curvilinear fish bone embedded at the back of his left tongue (near the region of his voicebox). The endoscope has a working channel that allows Dr Gan to insert a grasping forceps. This enables the bone to be extracted safely under direct vision. The process took about a minute and his pain resolved immediately.

Swallowed fish bone is one of the most common ENT emergencies seen in Singapore. The most common sites for a fish bone to get stuck in the throat are the tonsils (2 oval-shaped glands at the back of your throat), back of the tongue (in areas known as base of tongue and valleculae) and the food pipe (known as esophagus).

While most fish bones stuck in the throat region can be removed with a pair of forceps in the clinic, those that are stuck in the food pipe are much more difficult to get to and will have to be removed under general anaesthesia (with patient asleep). Fish bone in the food pipe are removed by passing a rigid scope (A long lighted tube) down the food pipe. The visualized fish bone can then be removed with and a grasping forceps that is passed through the rigid scope. Most swallowed fish bones can be removed without any complications. However, a swallowed fish bone that has been left embedded in the throat or food pipe for a prolonged period of time has a risk of infection and migration of the fish bone into deeper structures in the neck. Migrated fish bone causing injury to one of the large blood vessel in the neck resulting severe bleeding and death has happened before in Singapore. Hence, fish bones stuck in the throat or food pipe are serious conditions that warrants urgent intervention!

The first thing that you should do if you choked on a fish bone is to head to the nearest GP clinic, ENT clinic or A&E in the hospital. It should be removed by a trained doctor who has the necessary equipment to remove the bone. Trying to dig out the bone with your fingers or to flush it down with rice are not recommended as these action can lead to more injuries, migration of the fish bone or penetration of the fish bone deeper into the neck. Contrary to popular believe, drinking vinegar will not dissolve the bone.

To prevent accidental choking of or swallowing a fish bone, one should :

• Avoid swallowing fish with bones together with rice in one spoonful. Eat them separately.
• Avoid talking or laughing when eating fish meat with bones
• Avoid rushing when eating fish with bones
• Remove all visible fish bones on the plate rather than putting a big piece of fish in your mouth to feel and “dissect” the bones out.