Management of Upper Airway Leech Infestations

Abstract

Purpose: Upper airway foreign body is one of the most encountered clinical situations in otolaryngology practice. In rare conditions, a living organism may be a foreign body in the upper airway. In this study, we demonstrate 19 patients with leech infestations in nose, nasopharynx, and larynx. Methods: This study was enrolled with 19 patients between 2012 and 2016 in a regional state hospital. All of the patients were admitted to clinic with these complaints: epistaxis, hemoptysis, coughing, foreign body sensation, and bloody stool. Results: There were 12 male and 7 female patients. The leech was in the nose in 12 patients, in nasopharynx in 6 patients, and in the larynx in only 1 patient. All leeches are removed under local anesthesia (except laryngeal presentation). No bleeding and complication were seen after extraction of leech. Conclusion: Leech can be easily diagnosed and managed in the upper aero-digestive tract without any complication and leech-associated disease.

Bloody Wiggler, a Case Report of a Leech in the Pharynx

“…Our patient presented with unexplained recurrent intermittent bleeding from the nose or throat, foreign body sensation and with a recent history of drinking or swimming in unsafe water. This clinical presentation is similar to cases reported especially in the at-risk groups like children, 3 , 6–9 elderly, 13 , 14 , 20 and mentally challenged persons. 12 Of the 19 cases reported in his series, Harun 3 found 15 children, with 10 being under 10 years of age, a range in which our patient lies.…”

“…This clinical presentation is similar to cases reported especially in the at-risk groups like children, 3 , 6–9 elderly, 13 , 14 , 20 and mentally challenged persons. 12 Of the 19 cases reported in his series, Harun 3 found 15 children, with 10 being under 10 years of age, a range in which our patient lies. The youngest reported case of leech infestation is of a 9-month-old child.…”

“… 2 The commonest risk factors for getting hirudiniasis are visiting or living in rural areas, wild environments, or contact with polluted water from streams, pools or springs, whether through drinking it or swimming in it. 1 , 3 Once the leech attaches to the skin or mucosal surface using its anterior sucker, it uses its saliva to anaesthetize the site of its attachment. 1 , 4 Therefore, its host does not feel pain.…”

“… 1 , 4 Leeches in otolaryngology practice have been reported commonly in the nose 2 , 3 , 6 , 11–14 followed by the pharynx 7 , 10 (nasopharynx, 3 , 9 oropharynx 6 , 15–17 then hypopharynx 7 , 18 ) and rarely in the larynx 3 , 5 , 6 , 19 , 20 and trachea. 21 , 22 They lead to epistaxis, 3 hemoptysis, 6 , 15–17 foreign body sensations, 3 voice hoarseness 20 and sometimes cause airway obstruction 21 depending on the site. In this case, we report a leech at the junction of the nasopharynx and oropharynx that caused epistaxis and hemoptysis, a few days after ingestion of polluted water.…”

A Rare Cause of Hemoptysis: Oropharyngeal Leech

“…The most common clinical feature of leech parasites is nasal infestation and recurrent unexplained epistaxis (8). In a 19-patient study conducted between 2012 and 2016, it was shown that all patients (12 nasal, 6 nasopharynx, 1larynx) presented with at least one of the following findings: epistaxis, hemoptysis, coughing, foreign body sensation at the site, and bloody stool (9). In our case, hemoptysis and shortness of breath due to leech attachment to the oropharyngeal region and mild anemia were observed.…”