Foreign body aspiration, a continuously growing challenge: Tanta University experience in Egypt
Introduction
Aspirated foreign bodies (FBs) continue to present challenges to otolaryngologists [1]. History of the first paroxysm of cough and suffocation is valuable for clinical diagnosis. However, there may be a symptomless period after first paroxysm, which may vary in duration from few days to even months. Subsequent wheezing, cough, choking, sudden onset of asthma, and recurrent or non-resolving pneumonia point towards a possible FB aspiration [2]. The nature and spectrum of aspirated FBs differ according to age, sex, life style, and eating habits. It is observed that peanut, seeds, and plastic objects are commonly inhaled in young children who explore their world by introducing every thing in their mouths and do not have premolars or molars to grind smaller inhalable pieces effectively [3]. Furthermore, they have an immature protective cough reflex, compared to adults. Hence, morbidity and mortality are higher in children [4], [5].
Some reported that FB aspiration is uncommon in adults [6]. However, a unique form of FB aspiration is recently described among young girls and women who wear headscarves [7], [8]. Sharp pins are commonly used to fasten the headscarf in place where it is a common practice to hold the pins between the teeth while both hands are used to adjust the headscarf. Aspiration usually happens during talking or laughing while the head is tilted backward [9], [10], [11].
In Egypt, especially in the Delta region, the prevalence of FB aspiration is high. The type of FBs that is most frequently seen in this geographic area and the incidence of FB aspiration in relation to age, sex, and habits of people have been studied and analyzed.
Section snippets
Patient population and evaluation
Three thousand six hundred bronchoscopies were performed to remove FBs between January 1990 and December 2009 in Otolaryngology Department, Tanta University Hospital, Egypt. After the departmental approval, information was retrospectively gained from the charts. The patients were divided into two groups according to the age. Group A includes patients up to 10 years old, and group B includes those above 10 years. The patients of each group were investigated with respect to sex, history of FB
Results
Out of 1650 patients in group A, 928 (56.3%) were males and 722 (43.7%) were females, whereas, a total of 1950 patients in group B showed 47 (2.4%) males and 1903 (97.6%) females. The difference in male to female ratio in group A (1.3:1) was not statistically significant while it was highly significant in group B (1:40.5). The youngest patient in group A was 4 months (mean 2.8 ± 1.6 years, median 3 years) and the oldest in group B was 65 years old (mean 16.7 ± 3.2 years, median 14 years) (Table 1).
Discussion
Foreign body aspiration is a common medical emergency in all ages with serious and potentially lethal consequences. Darrow and Holinger [12] reviewed multiple case series and found that children younger than 5 years of age account for approximately 84% of cases. However, Eroglu et al. [13] observed that FB aspiration was common in adults than in children. They attributed this result to the wide spread habit of wearing a headscarf and fastening it with pins due to certain believes and
Conclusion and recommendation
Foreign body aspiration represents a continuous and growing problem in Lower Egypt not only in young children but also in adolescents and adults. The spectrum and frequency of FB aspiration differ according to the patients’ age, sex, feeding habits, traditions and believes, socio-cultural, educational, and economic status. A high index of suspicion and rapid hospital admission were crucial for proper diagnosis and management. Following a strict protocol in diagnosis and bronchoscopic evaluation
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