Elsevier

Auris Nasus Larynx

Volume 38, Issue 1, February 2011, Pages 88-94
Auris Nasus Larynx

Foreign body aspiration, a continuously growing challenge: Tanta University experience in Egypt

https://doi.org/10.1016/j.anl.2010.05.010Get rights and content

Abstract

Objective

To evaluate the different factors that affect the spectrum and frequency of foreign body (FB) aspiration as a growing problem in different ages, and express the experience of our department in managing the problem in the recent two decades.

Methods

The charts of 3600 patients who underwent bronchoscopic evaluation over a period of 20 years for a suspicion of FB inhalation were reviewed. The patients were divided according to the age into group A; up to 10 years, and group B; more than 10 years. Each group was investigated and compared with the other with respect to sex, history of FB aspiration, time elapsed between aspiration and hospital admission, clinical and radiographic findings, and FB location, type, retrieval, and complications. Seasonal, geographic, and socio-cultural factors and frequency of FB aspiration in relation to the study period were also recorded.

Results

In group A, boys were affected more than girls (1.3:1), while in group B, females were affected more than males (40.5:1). Among history positive patients in group A (72.8%) and B (96.8%), FB was detected in 88% and 97% respectively, while among history negative patients, FB was found higher in group A (49%) than group B (25%). The time elapsed before admission was longer in group A than group B. Cough was the most prominent symptom, while decreased breath sounds was the commonest sign in both groups. Pneumatic infiltration was the most frequent radiographic finding in group A (33.6%), while radio-opaque FB was higher in group B (94.1%). Peanut (67.3%) and seeds (21.2%) were the commonest FBs detected in group A, whereas, headscarf pins (91.3%) were predominant in group B. Foreign bodies were almost equally distributed in the laryngotracheobronchial tree in group A, while the left bronchial tree was much more affected in group B. Rigid bronchoscopy was used in groups A and B with a success rate of 99.8% and 99.7% respectively, while flexible bronchoscopy was only used in 0.2% in group B. Complications such as laryngotracheal edema (16.6%) and pneumothorax (2.3%) were encountered in group A more than group B (3.1%, 1.2%) and there was no mortality. Most of the aspirated FBs were recorded during summer months and commonly detected in patients of low socio-cultural status in both groups.

Conclusion

Foreign body aspiration is a continuously growing problem in Lower Egypt affecting all ages with two peaks at 3 and 14 years old. The rate of FB aspiration was affected by age; sex; traditions and believes; and seasonal, geographic, and socio-cultural factors. A high index of suspicion, rapid hospital admission, and bronchoscopic evaluation by experienced specialists were crucial for successful retrieval of the FB with low rate of morbidity. Public awareness through mass media needs attention to decrease the growing rate of this problem.

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

References (27)

  • E.M. Friedman

    Tracheobronchial foreign bodies

    Otolaryngol Clin North Am

    (2003)
  • N. Saki et al.

    Foreign body aspirations in infancy: a 20-year experience

    Int J Med Sci

    (2009)
  • O. Göktas et al.

    Foreign body aspiration in children: field of a German hospital

    Pediatr Int

    (2010)
  • Cited by (0)

    View full text