Hazards of microwave cooking: direct thermal damage to the pharynx and larynx

Pill Ingestion and Caustic Laryngeal Injury

OBJECTIVE

To highlight an unusual mechanism of laryngeal injury.

METHODS

Case report and literature review.

RESULTS

A 66-year-old male ingested an over-the-counter preparation of bile acids as a dietary supplement. The capsule lodged in the patient's pharynx, and he sustained a caustic injury to the supraglottic and glottic larynx. His injury was managed conservatively, and his symptoms gradually resolved over a period of 8 weeks. A follow-up laryngoscopy at 8 weeks and 6 months showed no signs of injury. A barium swallow at 8 weeks was normal at that time and videostroboscopy results normalized with resolution of the injury as well.

CONCLUSIONS

Caustic injury to the upper aerodigestive tract from pill ingestion is uncommon, and laryngeal injury even less so. Urgent evaluation should be undertaken, and appropriate therapies instituted promptly. Laryngeal injury can respond to conservative therapy, but there is a lack of clinical information to evaluate optimum treatment of this unusual injury.

Fatal laryngeal burn from ingestion of a hot fish cake: Case report and literature review

INTRODUCTION

Laryngeal burn from hot food ingestion is a rare but potentially life-threatening presentation. It is essential that clinicians have a high index of suspicion of potential airway obstruction in such cases. To our knowledge, this is the only case of fatal laryngeal oedema caused by hot solid food ingestion reported in the literature.

PRESENTATION OF CASE

A 51 year old male presented to the Emergency Department complaining of a burn to the throat following ingestion of a piping hot fish cake. On initial assessment he reported only mild pain and increased saliva production. There was no evidence of stridor, dysphagia, dyspnoea or aspiration and hence the patient was discharged and advised to return if he experienced any worsening of his symptoms. 2 h later the patient collapsed at home and died due to airway obstruction from delayed laryngeal oedema.

DISCUSSION

27 cases of laryngeal burn from ingestion of hot food or liquid were identified in the literature. Only one fatality following ingestion of hot liquid has been reported. This is the first documented fatal laryngeal burn due to ingestion of hot solid food. At present, there are no guidelines for the assessment and management of laryngeal contact burns.

CONCLUSION

Patients may be relatively asymptomatic immediately after thermal injury to the larynx. Endoscopic examination of the larynx is required to identify laryngeal oedema. Any sign of thermal injury to the laryngeal mucosa warrants admission for observation and definitive management of the airway should be considered.

An adult case of laryngopharyngeal burn by drinking hot water

Case

A 61‐year‐old man who was hospitalized with schizophrenia in a psychiatric hospital drank hot water estimated to be 90°C. Eight hours after injury, laryngopharynx edema gradually progressed, and his breathing deteriorated. Upon arrival at our emergency room, we secured his respiratory tract by nasal intubation under a bronchoscope.

Outcome

The edema gradually improved after peaking at hospital day 2, and he was extubated on hospital day 18. There were no apparent respiratory or esophageal problems, and he was discharged back to the psychiatric hospital on day 28.

Conclusion

These types of laryngopharynx burns caused by ingesting hot foods or drinks have been rarely reported for adults. In cases of adults, when the patient is in a special situation such as having a psychiatric disorder, it is necessary to assume that the laryngopharynx burns might be aggravated.

Facial burns from exploding microwaved foods: Case series and review

INTRODUCTION

Microwave ovens allow for quick and simple cooking. However, the importance of adequate food preparation, prior to microwave cooking, and the consequences of inadequate preparation are not well-known.

METHOD

The authors conducted a retrospective outcome analysis of all patients who sustained facial burns from microwaved foods and were treated at a UK regional burns unit over a six-year period. Patients were identified from clinical records.

RESULTS

Eight patients presented following inadequate preparation of either tinned potatoes (n=4) or eggs (n=4). All patients sustained <2% total body surface area facial burns. Mean age was 41 years (range 21-68 years). Six cases (75%) had associated ocular injury. One received amniotic membrane grafts; this individual's vision remains poor twelve months after injury.

DISCUSSION

Rapid dielectric heating of water within foods may produce high steam and vapour pressure gradients and cause explosive decompression [1,5,11]. Consumers may fail to recognise differential heating and simply cook foods for longer if they remain cool on the outer surface. Education on safe use and risks of microwave-cooked foods may help prevent these potentially serious injuries.

CONCLUSION

Microwave ovens have become ubiquitous. The authors recognise the need for improved public awareness of safe microwave cooking. Burns resulting from microwave-cooked foods may have life-changing consequences.

Microwave oven injuries in patients with complex partial seizures

Microwave ovens are often recommended as a safe cooking alternative for persons with epilepsy. We report four patients who suffered serious burns to their hands while handling microwave-heated liquids during a complex partial seizure (CPS). Injuries were due to the contact of the skin with a very hot container. The fact that all patients held on to the hot containers despite being burned and that they did not remember experiencing any pain at the time of the accident indicates that neither high temperatures nor pain will prevent patients who are having a CPS from suffering this type of injury. Unfortunately, there is no foolproof way to prevent the individual from opening the oven and removing its contents during a CPS. The only solution for this problem is "prevention"-individuals with poorly controlled CPS should be cautioned about these risks. The use of microwave settings that permit the heating but not boiling of liquids and the use of gloves while heating food and liquids to scalding temperatures may minimize the risk of this type of injury.

Exploding microwaved eggs--revisited

Different types of injuries are described as caused by the use of microwave ovens. Four of 41 burns from microwave ovens, presented by an international survey in 1986, were due to exploding microwave-heated eggs. Careful review of the English language literature through a Medline search from 1966 to 2000 was performed, in search of burns caused by exploding eggs. Clinical information from the published articles was reviewed and missing information was completed by e-mail correspondence with authors. Our own case was added to the collected data, and a total of 13 cases were analyzed. The average age of patients was 24.3 years (range, 7-49 years). All patients suffered from superficial burns of the mid and upper face, namely the forehead, periorbital region, dorsum of nose and malar areas. All patients with information available complained of ocular disturbances, and three suffered long-term decrease in visual acuity. Long-term skin complications were not reported. In summary, the clinical presentation of a facial injury from an exploding microwave-heated egg is relatively constant and mild. Favorable outcome can be expected but a meticulous ophthalmologic evaluation and a close follow-up are mandatory for prevention of long-term sequelae.

Salmonella outbreak from microwave cooked food

Following a buffet meal served to six guests at a private domestic function, five of the guests and the host developed symptoms of food poisoning. Salmonella enteritidis phage type 4 (PT4) was isolated from all four individuals who submitted faecal samples for investigation. Leftover samples of a savoury rice dish consumed by all six ill persons contained 6 x 10(3)/gm Salmonella enteritidis PT4. The rice salad comprised boiled rice, raw carrots, eggs, cheese and curry powder. The curry powder and remainder of the pack of six eggs were negative on microbiological analysis. The rice dish had been prepared by heating in a 500 W microwave oven with a rotating turntable on full power for 5 min. Although the hazards of inadequate microwave cooking are well recognized, this is only the second outbreak of food poisoning from microwave cooking to be reported.