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Muacevic A, Adler JR. Management of Foreign Bodies in the Ear, Nose and Throat in Pediatric Patients: Real-Life Experience in a Large Tertiary Hospital. Cureus 2022; 14:e30739. [PMID: 36457611 PMCID: PMC9705068 DOI: 10.7759/cureus.30739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Foreign body (FB) injuries occur frequently in children. The aim of this paper is to provide an update on the experience of the Department of Otolaryngology, San Camillo Forlanini Hospital in Rome concerning the management of FB injuries in children. METHODOLOGY This study was carried out by collecting data from the medical reports of our Pediatric Emergency Room stored between 2007 and 2021. Inclusion criteria were diagnosis of FB in pediatric patients based on the ENT evaluation. Pediatric patients included children and preteens ranging from six months to 15 years. RESULTS Between 2007 and 2021, 1,623 cases of FBs in young patients (840 males, 783 females, mean age: 5.5 years) were observed at the Pediatric Emergency Room and treated by the ENT Department. The ear was the most frequently involved site (700 patients), followed by the nose (517 cases), pharynx (319 cases), mouth (76 patients) and airways (11 cases). The most common management strategy was FBs' removal in the emergency room and home discharge (1,409 patients), 99 cases required outpatient discharge, 64 patients moved away from the Emergency Care refusing treatment, 35 patients were hospitalized, 10 patients refused hospitalization, five were transferred to the pediatric hospital and one died in the emergency room. CONCLUSIONS A quick diagnosis of FB followed by an effective removal is crucial to avoid injuries and complications. Surveillance registries have a key role in the prevention and management of FB injuries. Moreover, it is necessary to train medical and nursing staff of emergency, pediatric and otolaryngologist departments to best recognize and manage FB injuries.
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Reyad HM, El-Deeb ME, Abbas AM, Sherief D, Elagamy OA. Foreign Body Aspiration in Egyptian Children Clinical, Radiological and Bronchoscopic Findings. J Multidiscip Healthc 2021; 14:2299-2305. [PMID: 34465998 PMCID: PMC8403025 DOI: 10.2147/jmdh.s326967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Foreign body aspiration (FBA) is a frequent cause of childhood morbidity and mortality. Diagnosis of FBA is challenging in the absence of a witnessed aspiration event. The aim of this study was to determine the accuracy of presenting symptoms as well as physical and radiologic findings as predictors of FBA in children. Thus, indications for bronchoscopy could be determined in such cases. Methods This retrospective cohort study was conducted in the ENT department, Kafr-elsheikh University Hospital. The medical records of patients younger than 16 years old who underwent rigid bronchoscopy for suspected FBA were included. Data including age, gender, symptoms, physical examination findings, radiological features, nature and location of foreign body, and outcome of the bronchoscopy were collected. Results This study included 130 patients, 105 (80.8%) patients were positive for the presence of a foreign body in their airways. Foreign bodies were most frequently (43.8%) lodged in the right main bronchus, and nuts (66.7%), were the most commonly retrieved. Multivariate regression analysis identified the presence of suggestive signs or symptoms as independent predictors of FBA on rigid bronchoscopy. Conclusion Objective finding of clinical signs eg unilateral wheezes on chest examination in the presence of symptoms such as a sudden cough, dyspnea, and hoarseness could predict FBA and help physicians in deciding bronchoscopy.
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Affiliation(s)
- Heba M Reyad
- Department of Pediatrics, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Mohamed E El-Deeb
- Department of Otorhinolaryngology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Ahmed M Abbas
- Department of Pediatrics, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Dalia Sherief
- Department of Clinical Pathology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Osama A Elagamy
- Department of Pediatrics, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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Alharbi N, Dabbour M. Aspiration of superabsorbent polymer beads resulting in focal lung damage: a case report. BMC Pediatr 2020; 20:262. [PMID: 32471401 PMCID: PMC7257448 DOI: 10.1186/s12887-020-02168-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 05/21/2020] [Indexed: 11/16/2022] Open
Abstract
Background Concerns have recently been raised about reported incidents of intestinal obstruction following ingestion of Superabsorbent polymer (SAP) beads. Texas Poison Centers reported 110 cases of superabsorbent polymer bead ingestions between 2011 and 2016 (Pediatr Emerg Care 35:426-7, 2019). Furthermore, cases of related auditory complications following the placement of SAP beads into the external auditory canal have also been reported. Here, we report the first case of significant airway damage secondary to the ingestion of a SAP bead (Orbeez), which was aspirated and then overlooked. Further, we hypothesized that the capability of the bead to expand in size once exposed to water from the respiratory mucous may contribute to airway damage. Case presentation A 3-year-old boy presented to our hospital with persistent cough and recurrent hospitalizations to the general ward and intensive care unit. The boy was diagnosed with focal lung bronchiectasis in the left lower lobe, which occurred after the patient aspirated an Orbeez bead before a year. The bead was removed using flexible bronchoscopy and a retrieval basket. Conclusion Orbeez beads are commonly ingested by young children resulting in gastrointestinal obstruction. The beads can easily be aspirated by children and overlooked by their caregivers and physicians for long periods of time due to their small size. The bead can cause significant airway damage after multiplying in size when coming into contact with respiratory mucus which consists of 95% water.
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Affiliation(s)
- Nasser Alharbi
- Department of Pediatrics, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia.
| | - Maryam Dabbour
- Pediatric Pulmonology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Correlation between recovery time of extended high-frequency audiometry and duration of inflammation in patients with acute otitis media. Eur Arch Otorhinolaryngol 2020; 277:2447-2453. [PMID: 32333137 DOI: 10.1007/s00405-020-05973-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To explore the rule of extended high-frequency (EHF) audiometry recovery in patients with acute otitis media. METHODS From January 2016 to July 2019, patients with acute otitis media in the outpatient department of otology were studied. The diagnosis was made according to the otoscopy and acoustic impedance tests, and antibiotics and other treatment programs were given. The patients were followed up to compare the effects of different recovery time on extended high-frequency audiometry in patients with acute otitis media. RESULTS 146 patients with acute otitis media (69 in the left ear and 77 in the right ear) were selected for observation and follow-up. The patients were divided into three groups according to the time from the onset to the disappearance of hyperacusis and earache symptoms: ≤ 5 days group (26 patients, 17.8%), 6-10 days group (74 patients, 50.7%), and > 10 days group (46 patients, 31.5%). The threshold of EHF in the study group was significantly higher than that in the control group in the early stage. According to the study design for follow-up, we found that with the prolongation of the duration of acute otitis media, the extended high frequency of different groups had different changes. CONCLUSIONS Our results show that the recovery time of EHF in patients with acute otitis media was later than that of the standard audiogram and was closely related to the course of the disease. This is of great significance for discovering the hidden hearing loss of the patients and taking the treatment plan as soon as possible.
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Flexible Bronchoscopy Combined with Rigid Bronchoscopy for Treatment of Scarring in the Bronchus Caused by a Foreign Body. Case Rep Med 2019; 2019:4616298. [PMID: 31316565 PMCID: PMC6604489 DOI: 10.1155/2019/4616298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/16/2019] [Accepted: 05/15/2019] [Indexed: 12/17/2022] Open
Abstract
Foreign body (FB) aspiration into the tracheobronchial tree is an emergency in the pediatric department, particularly in children aged <3 years. FB granulation tissue is commonly found in children with FB aspiration. However, scarring in the bronchus caused by a FB is rare. We herein report a case involving aspiration of a plastic whistle toy with scarring in the bronchus. The scar tissue was successfully removed by interventional bronchoscopy combined with a flexible electrosurgery probe and carbon dioxide cryotherapy.
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Tracheobronchial foreign bodies have never been so strange! TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:260-264. [PMID: 32082743 DOI: 10.5606/tgkdc.dergisi.2018.14455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/02/2017] [Indexed: 11/21/2022]
Abstract
Background In the present study, we aimed to present our experience about retrieval of foreign bodies over a 28-year period. Methods We retrospectively analyzed the files of 22 patients (18 males, 4 females; mean age 34.9 years; range, 9 months to 80 years) who required removal of a foreign body from the tracheobronchial tree between April 1987 and December 2015. Results A total of 72.7% of the study group were 10 years old or older. There was no history of aspiration in 37% of cases, most often in older patients. Of the 22 unusual foreign bodies, seven (31.8%) were aspirated through permanent tracheostomy. The strangest foreign bodies were grass inflorescences, an acacia thorn, and construction nail. The foreign bodies were removed by rigid bronchoscopy in 18 patients, while thoracotomy was performed in two patients, and pericardiotomy in one patient. No intervention was required in one patient. Conclusion The elderly and patients with tracheostomies may aspirate unusual foreign bodies. Even if there is no history of aspiration, the differential diagnosis of c ough or dyspnea should include foreign body aspiration.
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Gruber M, van Der Meer G, Ling B, Barber C, Mills N, Neeff M, Salkeld L, Mahadevan M. The bacterial species associated with aspirated foreign bodies in children. Auris Nasus Larynx 2017; 45:598-602. [PMID: 28779997 DOI: 10.1016/j.anl.2017.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 04/04/2017] [Accepted: 07/11/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Inhaled foreign bodies in children are common and may be complicated by secondary airway tract infection. The inhaled foreign body may act as carrier of infectious material and the aim of this study was to explore the bacterial species associated with aspirated foreign bodies in a cohort of children. METHODS Retrospective case series of 34 patients who underwent rigid laryngobronchoscopy because of foreign body aspiration. Each patient had a sample taken from tracheobronchial secretions during the procedure. RESULTS The average patient age was 31.2 months and the average hospital stay was 2.5 days. Of the foreign bodies 24 (71%) were organic in nature and 10 (29%) were non-organic. Twenty eight (82.3%) patients had mixed oropharyngeal flora organisms growth. Fifteen (44%) samples were positive for organisms other than oropharyngeal flora with the most common cultured organisms being: Streptococcus pneumonia (4/12%), Haemophilus influenza (4/12%), Moraxella catarrhalis (4/12%). Four samples (12%) grew a fungus; Candida albicans was cultured in 3 patients and Aspergillus glaucus was identified in one sample. Of the non-oropharyngeal organisms 7(47%) demonstrated antibiotic resistance with four having resistance to amoxycillin, two resistant to penicillin and one resistant to cotrimoxazole. CONCLUSION Some children who present with aspirated foreign body may be complicated with secondary airway infection. Antibacterial treatment might be considered in some of these cases. The regimen of antibiotics should aim to cover oropharyngeal flora, S. pneumonia, H. influenza and Moraxella catarrhalis.
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Affiliation(s)
- Maayan Gruber
- Paediatric Otolaryngology Unit, Starship Children's Hospital, Auckland, New Zealand; Faculty of Medicine, Bar-Ilan University, Israel.
| | - Graeme van Der Meer
- Paediatric Otolaryngology Unit, Starship Children's Hospital, Auckland, New Zealand
| | - Benjamin Ling
- Paediatric Otolaryngology Unit, Starship Children's Hospital, Auckland, New Zealand
| | - Colin Barber
- Paediatric Otolaryngology Unit, Starship Children's Hospital, Auckland, New Zealand
| | - Nikki Mills
- Paediatric Otolaryngology Unit, Starship Children's Hospital, Auckland, New Zealand
| | - Michel Neeff
- Paediatric Otolaryngology Unit, Starship Children's Hospital, Auckland, New Zealand
| | - Lesley Salkeld
- Paediatric Otolaryngology Unit, Starship Children's Hospital, Auckland, New Zealand
| | - Murali Mahadevan
- Paediatric Otolaryngology Unit, Starship Children's Hospital, Auckland, New Zealand
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Eyekpegha OJ, Onakpoya UU, Obiajunwa PO, Famurewa OC, Ogunrombi AB. Missed Distal Tracheal Foreign Body in Consecutive Bronchoscopies in a 6-year-old Boy. Niger J Surg 2017; 23:67-70. [PMID: 28584516 PMCID: PMC5441221 DOI: 10.4103/1117-6806.199957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
It is unusual but not uncommon for foreign bodies to be missed at bronchoscopy. This case report highlights the importance of the clinical history in the diagnosis of aspirated foreign bodies and the usefulness of chest imaging modalities. A 6-year-old boy presented with recurrent breathlessness and cough of 2 months. He was said to have aspirated the base cap of a pen at about the time symptoms started. He had two sessions of rigid bronchoscopy and a session of flexible bronchoscopy at three different hospitals. He had an initial rigid bronchoscopy which failed to show the foreign body (FB). A chest computerized tomographic scan demonstrated the FB, which was retrieved at combined flexible/rigid bronchoscopy. Although rigid bronchoscopy is the gold standard for managing airway foreign bodies, there remains a false negative rate for this procedure and where necessary, appropriate imaging may compliment rigid bronchoscopy, especially where there is some confusion.
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Affiliation(s)
- Oghenevware Joel Eyekpegha
- Department of Surgery, Cardiothoracic Surgery Unit, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Uvie U Onakpoya
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Perpetua O Obiajunwa
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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Salih AM, Alfaki M, Alam-Elhuda DM. Airway foreign bodies: A critical review for a common pediatric emergency. World J Emerg Med 2016; 7:5-12. [PMID: 27006731 PMCID: PMC4786499 DOI: 10.5847/wjem.j.1920-8642.2016.01.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 01/12/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Airway foreign bodies (AFBs) is an interdisciplinary area between emergency medicine, pediatrics and otolaryngology. It is a life-threatening condition that is not infrequently seen; however, it is poorly covered in medical literature. Accidental aspiration of an element into airways is a widespread clinical scenario among children under 3 years, predominantly males. Moreover, it is the leading cause of infantile deaths and the fourth one among preschool children. DATA RESOURCES A systemic search was conducted in July 2015 using PubMed/PubMed Central Database of The National Center for Biotechnology Information (NCBI) (http://www.ncbi.nlm.nih.gov/). A total of 1 767 articles were identified and most of them were meta-analyses, systematic reviews, and case series. Those thoroughly discussing assessment and management of AFBs were retrieved. RESULTS AFBs episodes may be either witnessed or missed. Presence of a witness for the inhalation is diagnostic. The later usually present with persistent active cough. A classical triad of paroxysmal cough, wheezing, and dyspnoea/decreased air entry was reported, though many presentations have inconsistent findings. Hence, diagnosis requires high index of clinical suspicion. Flexible fibro-optic bronchoscopy is the gold standard of diagnosis, whereas inhaled objects are best retrieved by rigid bronchoscopes. CONCLUSIONS Close supervision of pediatrics is the hallmark of prevention. Caregivers should ensure a safe surrounding milieu, including the toys their offspring play with. Immediate complications result from direct obstruction or injury by the inhaled object. Alternatively, prolonged lodging traps air and induces inflammatory response causing atelectesis and pneumonia, respectively.
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Affiliation(s)
- Alaaddin M Salih
- Faculty of Medicine, International University of Africa, Khartoum, Sudan
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Musab Alfaki
- Ribat University and Central Police Hospitals, National Ribat University, Khartoum, Sudan
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Safari M, Manesh MRH. Demographic and Clinical Findings in Children Undergoing Bronchoscopy for Foreign Body Aspiration. Ochsner J 2016; 16:120-4. [PMID: 27303219 PMCID: PMC4896653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Foreign body aspiration (FBA) is a significant cause of airway distress, mortality, and morbidity in children. Diagnosis of FBA can be challenging and is sometimes delayed for weeks or even months. If not diagnosed and treated promptly, FBA can result in serious consequences. METHODS For this retrospective study, we investigated the medical records of 89 children who underwent bronchoscopy for suspected FBA and recorded relevant demographic, clinical, and treatment data. RESULTS Of the 89 patients identified for this study, 51 had a definitive diagnosis of FBA. Among these patients, choking, chronic cough and wheezing, cyanosis, and dyspnea were the most frequent symptoms of FBA. The foreign bodies were located in the left bronchus (45.1%), the right bronchus (35.3%), the trachea (15.7%), and in both the right and left bronchi (3.9%). Seeds were the most prevalent foreign body, found in 39.2% of the patients. CONCLUSION Lack of complete medical history in patients with suspected FBA is one of the main causes of delayed FBA diagnosis. Bronchoscopy is considered the definitive diagnostic method for FBA and should be conducted in all patients with suspected FBA because of the low risk of complications and reduced probability that FBA diagnosis and treatment will be delayed.
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Affiliation(s)
- Mojgan Safari
- Department of Pediatrics, Immunology and Allergy Ward, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Reza Hashemi Manesh
- Department of Pediatrics, Immunology and Allergy Ward, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Cardiology, Tehran University of Medical Sciences, Tehran, Iran
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Colavita L, Gelli C, Pecorari L, Peroni DG. A history of recurrent wheezing can delay the diagnosis of foreign body aspiration in a paediatric emergency department. BMJ Case Rep 2015; 2015:bcr-2015-211946. [PMID: 26351317 DOI: 10.1136/bcr-2015-211946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Foreign body aspiration (FBA) into the airways is a potentially life-threatening event, and more frequent in children younger than 3 years of age; it can mimic other diseases by its frequently non-specific clinical and radiological presentation. The commonest misdiagnoses in children are asthma and recurrent respiratory tract infections with wheezing. This often makes it particularly difficult for a timely and proper diagnosis, especially when there is a silent history of FBA (not a rare occurrence in the age group at highest risk). We report a case of a 2-year-old boy who arrived at the emergency department at the Hospital of Ferrara, with dyspnoea, fever and wheezing, which had started 12 h after aspiration of a pistachio. The asymptomatic period after the pistachio aspiration, a history of recurrent wheezing during respiratory infections and the non-specificity of clinical and radiological findings, delayed the right diagnosis of FBA.
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Affiliation(s)
- Laura Colavita
- Department of Genetics and Pediatric Immunology, University Hospital of Messina, Messina, Italy
| | - Claudia Gelli
- Department of Pediatrics, University Hospital "Sant'Anna" of Ferrara, Ferrara, Italy
| | - Lisa Pecorari
- Department of Pediatrics, University Hospital "Sant'Anna" of Ferrara, Ferrara, Italy
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