3 Sep, 09 | by BMJ
I am now working in the department of ear, nose and throat (ENT) and I have come across my all time favourite medical saying: “A thyroid is like a lady’s handbag – you never know what you might find!” This was said with glee by one of my consultants during a thyroidectomy. His point being that the neck can contain a surprisingly large thyroid compared to what you might have predicted on clinical examination. However, I would like to take this one step further and say that ENT in general can be on occasions similar to ladies’ handbags.
Like many other women, I have a superhuman power of finding all manor of objects in the smallest of handbags. In fact my boyfriend is never quite sure where it all appears from, nor seems to share my belief that it is all extremely useful! However, the same can be true for foreign bodies stuck in ears, noses and throats. Firstly, the foreign body is always bigger than you expect, secondly, often people strangely can’t remember how the object actually got there and finally, it is never useful!
Since starting in ENT some 4 weeks ago I have retrieved several foreign bodies from various orifices. These include a 4 cm long fish bone from a tonsillar fossa, a pea from a nose, part of an ear plug from an ear and the tip of a pen top from an ear. However, the most impressive foreign body was removed by one of the registrars from a young boy’s throat who had managed to hook the handle of a toilet brush into his tonsillar fossa leaving the brush end sticking out of his mouth. On this occasion the ‘handbag’ was quite literally overflowing!
In cases of foreign bodies lodged in small orifices I have now taken to guessing the age of my patient based on the type of object “lost.” For example if the object is a pea or marble the patient is likely to be a child, whilst in cases of fish bones or ear plugs the patient is likely to be an adult. However, sometimes it’s not quite so easy to tell. My ability to predict patient age came unstuck when I read a GP referral letter for a male patient who had rigorously scratched an itch in their ear canal with a pen top to the extent that the tip had broken off and became lodged in the ear canal. I was convinced this was a young boy but was surprised to find on checking the date of birth he was actually a 40 year old man! As the patient walked into my clinic room looking rather sheepish he said: “This is the closest I have come to feeling like a child since my children stopped giving me the excuse to play with Scalexctric!”
So from now on I shall think of my handbag whenever I think of the ear, nose, throat and of course the thyroid. You never know, maybe one day I might find some loose change, a tissue or the kitchen sink!
Helen Carnaghan is a Foundation Year 2 doctor in the Eastern Deanery and a member of BMJ Junior Doctor Advisory Panel.