Help, I Have a Fish Bone In my Throat!

Ingested foreign bodies are one of the most common cases that ENT Specialists see in the Accident & Emergency Department. These foreign bodies are most commonly fish bones as fish is a staple food in our local diet.  However, we have also witnessed patients accidently swallowing dentures and other foreign objects such as toothbrush handles.

Why is a fish bone in my throat one of the most common ENT complaints in Singapore?

In this study done in Singapore in 1994, it was found that the incidence of fish bone ingestion was significantly higher among Chinese patients as compared with Malay or Indian patients, which led to the postulation that the use of chopsticks and the traditional Chinese practice of deboning fish in one’s mouth (using the teeth, lips and tongue) may be associated with a higher risk of fish bone ingestion. The authors also found that people who wore dentures were at a higher risk of swallowing foreign bodies, possibly because the use of dentures impairs the wearer’s ability to detect foreign bodies in the food during chewing. 

 

Similarly, other studies conducted in Singapore and Hong Kong (which has a similarly high proportion of Southern Chinese) have reported a disproportionately higher prevalence of fish bone ingestion among the Chinese. This has led to the postulation that the Chinese habit of eating un-filleted fish with chopsticks may account for the higher prevalence of ingested fish bones in this population.

 

In Western populations, meat boluses are the most commonly encountered foreign bodies in the gastrointestinal tract. Western studies have shown that patients who are at risk of foreign body ingestion include denture wearers, alcoholics, prisoners, patients with psychiatric disorders and individuals with intellectual impairment.

What are some symptoms of fish bone in my throat?

A patient is likely to feel the fish bone as soon as it gets stuck. The cause of any discomfort is also likely to be immediately apparent.

 

Aside from general discomfort, there are several other possible symptoms of having a bone stuck in the throat, including:

  • Persistent coughing
  • A prickly or tingly sensation in the throat
  • Pain on swallowing
  • Difficulty swallowing
  • Sharp pain where the bone has impacted the throat
  • Spitting up blood

If you suspect that you have swallowed a fish bone, seek medical attention IMMEDIATELY at your nearest GP. If your GP is unable to retrieve the fish bone, you may be redirected to the A & E department for specialized care from an ENT Specialist.

Where do fish bones in my throat commonly get stuck?

Fish bones are get commonly stuck in the tonsils, or lower down in the throat at the base of the tongue.

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Fish bone stuck in right tonsil

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Fish bone stuck in the base of the tongue

How are fish bones in my throat removed?

Fish bones which are stuck in the tonsils can be removed simply with a pair of forceps. Fish bones which are stuck lower down in the throat may require removal with an endoscope under local anaesthesia. This special endoscope has a channel to insert a grasping tool to retrieve the foreign body.

bronchoscope

Endoscope used to remove fish bones

bronchoscope-grasper

Grasping instrument inserted through endoscope

On occasion, the fish bone may have entered the food pipe (esophagus) and embedded itself in the wall. In such cases, it may not be retrievable with the endoscope. You may require a general anaesthetic and a procedure termed rigid esophagoscopy to remove the foreign body. 

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Ingested fish bone in the proximal esophagus on a neck X-ray. This had to be removed with rigid esophagoscopy under general anaesthetic

What are some complications of fish bone in my throat?

Possible complications of having a fish bone in my throat include:

  • An inability to swallow food or eat
  • Bleeding from the throat
  • Fishbone puncturing the food pipe (esophagus)
  • Neck and chest infections
  • Abscess formation

Fortunately, with early diagnosis and treatment, most of these complications can be avoided.

What are some home remedies for fish bone in my throat?

There are several home remedies that are often suggested to help dislodge the fish bone. They include:

 

  • Sticking one’s finger down the throat to try and dislodge the foreign body
  • Coughing forcefully
  • Drinking / gargling a small amount of vinegar to help break the bone down with the acid
  • Drinking soda is postulated to produce gases in the stomach to help break down the bone
  • Drink 1 tablespoon of olive oil to help lubricate and free the bone
  • Swallow a large clump of rice or a large bite of a banana to dislodge the bone
  • Soak bread in water for a few seconds, then swallow a large chunk. This could dislodge the bone

In our experience, we have NEVER seen any of these home remedies successfully remove an embedded fish bone. Seek medical attention immediately if you suspect that you may have swallowed a fish bone and avoid further complications.

 

Please read our article for a patient who experienced ingesting a fish bone and its removal process.