Airway Foreign Bodies.

ObjectiveWe aim to determine the utility of CT scan as a method to accurately confirm pediatric airway foreign bodies (AFBs), the current gold standard of which is chest X-ray as the primary imaging modality in the investigation screening of AFBs with progression to microlaryngobronchoscopy.MethodsA retrospective cohort study of children diagnosed with suspected AFBs between July 2019 and June 2020 was conducted. The primary outcome of missed AFBs from radiologic investigations was recorded.ResultsA total of 226 children with an average age of 1.94 years were included in this study. One hundred and two children were eventually admitted to the hospital for microlaryngobronchoscopy. A total of 89 cases were initially examined by chest X-ray with the diagnosis confirmed in 26 cases. The initial examination was chest CT scan in 105 cases, of which the diagnosis was confirmed in 46 cases. The initial examination was chest CT scan with airway reconstruction in 32 cases, and the diagnosis was confirmed in 17 cases. Patients with negative chest CT scan with airway reconstruction were observed to have resolution of symptoms with no further need for bronchoscopy.ConclusionChest CT scan with airway reconstruction had the highest rate of confirmed diagnosis of pediatric AFBs on initial scanning, followed by chest CT scan, and finally chest X-ray with fluoroscopy; there was no missed diagnosis in chest CT scan with airway reconstruction. Chest CT scan with airway reconstruction can accurately and quickly detect AFBs and reduce unnecessary bronchoscopy.

Pediatric airway foreign bodies are potentially life-threatening situations. The otolaryngologist is often consulted to aid in the diagnosis and management of these difficult cases. Although radiographic studies are often obtained, the decision for surgical intervention is usually based on a suspicious history and physical examination. Our hypothesis is that radiographic imaging should not alter the decision for surgical intervention. We retrospectively reviewed the cases of pediatric airway foreign bodies managed by the otolaryngology department at St Louis Children's Hospital between December 1990 and June 1996 with both radiographic imaging and operative intervention. Ninety-three cases of potential aspiration were identified, with a median patient age of 20 months. The most common presenting signs and symptoms were aspiration event (n = 82), wheezing (n = 76), decreased breath sounds (n = 47), cough (n = 39), respiratory distress (n = 17), fever (n = 16), pneumonia (n = 14), and stridor (n = 7). At the time of endoscopy, 73 patients were found to have an airway foreign body. The sensitivity and specificity of the imaging studies in identifying the presence of an airway foreign body in the 93 patients were 73% and 45%, respectively. Our decision for operative intervention was based on the history and physical examination, and was not changed in the presence of a negative radiographic study. The routine use of radiography should not alter the management of airway foreign bodies, providing that there is a well-equipped endoscopic team familiar with airway foreign bodies.

Rigid bronchoscopy is the gold standard treatment for pediatric tracheobronchial foreign bodies. This procedure gives jitters to young ENT surgeons. The only aim of this study is to aware young ENT surgeons of different challenges they may face during bronchoscopy and their subsequent management. Clinical and demographic presentations of airway foreign bodies are also presented. This prospective observational study was conducted from Jan 2013 to Jan 2020 on patients with tracheobronchial foreign bodies. Patients were divided in four Groups (A, B, C and D) on the basis of mode of presentation. Rigid bronchoscopies using basic instruments without the use of telescope/telescopic forceps in patients fulfilling the inclusion/exclusion criteria were done by first author under the supervision of senior authors. The challenges and difficulties encountered and their subsequent management were noted. Out of seventy cases, maximum patients (50) were in the age group of 2-6years. Majority of patients (76.2%) in Group A and B in total reported to hospital within 0-2days. Majority of patients in Group A and B as a whole were educated as per our criteria while majority in group C were uneducated. Cough was the most common symptom seen in all groups at the time of examination. Decreased air entry abnormal breath sounds on examination were seen in 75%, 73%, and 100% of (patients in) Group A, B and C, respectively while it was normal for Group D. Most common X-ray finding was Hyperinflation followed by normal X-ray in group A and B. Most common Grade of modified Cormack-Lehane on direct laryngoscopy was Grade 1. Most common foreign body was nuts/legumes/pulses. Difficulty in inserting appropriate size rigid bronchoscope through vocal cords, Intraoperative drop in oxygen saturation, breakage of foreign bodies into pieces, stucking of forceps into tracheal mucosa, stucking of foreign body in sub glottis while removing and bleed/edema in old foreign bodies were main problems encountered. Rigid bronchoscopy is a life saving procedure. The sophisticated telescopes/forceps and other gadgets may not be always available. The young ENT surgeon should be well acquainted with basic instruments and their usage. The common difficulties/challenges faced should not cause panic as these challenges can be easily overcomed with simple maneuvers.

Plastic laryngeal foreign bodies in children: A diagnostic challenge

Aspiration of foreign bodies is an emergency condition in children and may result in death, especially in children under 3 years of age. Therefore, diagnosis and treatment must be made rapidly. This study sought to summarize our experience with endoscope-assisted rigid bronchoscopy (RB) in the diagnosis and treatment of pediatric tracheobronchial foreign body emergencies to reduce complications and mortality. This was a retrospective cross-sectional study. The medical records of 337 children diagnosed with clinically suspected airway foreign body aspiration in the pediatric emergency department were analyzed retrospectively. The patients were divided into 2 groups with endoscopy used during RB in group 1 whereas group 2 was RB only. The surgeons who performed the bronchoscopies completed a survey on the advantages/disadvantages of these 2 procedures. All of the patients had a positive history of suspected foreign body aspiration and foreign bodies were identified in 77.1% of the patients during RB. There were 161 (47.8%) patients in group 1 and 176 (52.2%) patients in group 2. In group 2, 5 patients showed transient hypoxia, and 6 patients had an episode of transient bleeding during the operations. These numbers were 3 and 3, respectively, in group 1. One patient in group 2 suffered cardiac arrest and died during surgery. The authors did not see any long-term complications after these operations and the authors did not find any statistically significant differences between the groups for complication rates. The RB is the gold standard procedure for removal of pediatric airway foreign bodies. The survey used in this study and our extensive experience have shown that the distal bronchi and foreign bodies can be visualized more effectively when using a rigid endoscope during RB, especially in children under the age of 3 years. In order to improve the safety of the surgical procedure, the authors propose that endoscope-assisted RB should be used in emergencies concerning foreign bodies in the airways of children.

An alternative method of management of pediatric airway foreign bodies in the absence of rigid bronchoscopy

Yield of preoperative findings in pediatric airway foreign bodies - A meta-analysis

Increased Rates of Peanut and Tree Nut Aspiration as a Possible Consequence of Allergy Prevention by Early Introduction

1. Joshua D. Rovin, MD* 2. Bradley M. Rodgers, MD† 1. 2. *Division of Pediatric Surgery, Children’s Medical Center, University of Virginia Health Sciences Center, Charlottesville, VA. 3. 4. †Editorial Board. After completing this article, readers should be able to: 1. Delineate the signs and symptoms of foreign body aspiration. 2. Explain the process of evaluating for suspected foreign body aspiration. 3. Describe the possible radiographic manifestations of foreign body aspiration. 4. Explain the management of foreign body aspiration in children. 5. Delineate the potential late complications of foreign body aspiration. Aspiration of foreign bodies by children can lead to serious illness and sometimes even death. According to National Safety Council statistics, in 1995, mechanical suffocation accounted for 5% (167) of all unintentional deaths among children in the United States younger than 4 years of age. Most of these deaths occurred in children younger than 1 year of age (81 deaths, accounting for 10% of all unintentional deaths in children younger than 1 year of age). Fortunately, the number of deaths has decreased over the past decade, which has been attributed to better education of the public and stricter guidelines for toy manufacturers. Nevertheless, foreign body aspiration continues to account for a significant number of preventable childhood deaths. Younger children are at the highest risk for accidental foreign body aspiration. This increased incidence has been attributed to several factors among younger children, including that they: 1) have the tendency to put small objects into their mouths; 2) often cry, shout, run, and play with objects in their mouths; and 3) do not have molars to chew certain foods adequately. Most studies show that fewer than 15% of foreign body aspirations occur among children older than 5 years of age. Boys comprise more than 50% of all cases of foreign body aspiration. By far, the objects aspirated most frequently are organic or food matter. In North America, peanuts are most common (Table 1⇓ ). View this table: Table 1. Commonly Aspirated Foreign Bodies Unlike aspiration in adults, there is only a …

Pediatric airway foreign body

The age of predilection for foreign body aspiration into the lower airway shows a bimodal distribution, with the majority of cases occurring in children or infants and in the elderly. Although several pediatric airway foreign bodies have been summarized, in adults, bronchial foreign bodies are relatively uncommon. There are a variety of symptoms induced by airway foreign bodies, although the typical symptoms of some bronchial foreign bodies are cough. Bronchial foreign bodies, especially in the elderly, may have few symptoms and it is necessary for careful identification. Therefore, it is very important to carefully perform medical consultations about current and past medical history. Herein, we report a case of an elderly Japanese with obstructive pneumonia with a bronchial foreign body of fish bone with a long history of cough. It is known that people in some countries such as Japan have a habit of eating fish. Therefore, it is necessary to more carefully explore the possibility of some bronchial foreign body such as a fish bone, when we observe symptoms of persistent cough in such countries.

Objective:To observe the clinical characteristics, pathogen infection and the diagnostic reliability of CT multiplanar reconstruction(CT MPR) in the children with airway foreign bodies.Method:We retrospectively reviewed 220 pediatric patients suspected with respiratory foreign bodies who were simultaneously examined by CT MPR, bronchoscopy and secretion culture.Then we summarized their characteristics from treatment process, age distribution, foreign body kinds, examination results of CT MPR, bronchoscopy and secretion culture. Result:Only 108 cases(49.09%) accepted bronchoscopy in 48 hours and the most risk age was 1 to 2 years old. We observed the commonest foreign bodies were peanuts, melon seeds and nuts. In addition, we found CT MPR was accurate in diagnostic airway foreign body with accuracy ratio was 94.09%. Furthermore, our secretion culture showed negative(64.09%) in 141 cases and positive(35.91%) in 79 patients. And the commonest pathogenic bacteria were staphylococcus aureus, streptococcus pneumoniae, haemophilus influenzae, pseudomonas aeruginosa,klebsiella pneumonia.Conclusion:Pediatric airway foreign bodies had its own clinical characteristics.When the medical units had no conditions to carry out bronchoscopy,CT MPR would be a good choice to rule out airway foreign body.Besides,most case only needed symptomatic treatment other than antibiotics after bronchoscopy.

Foreign body aspiration is a common pediatric problem that affects children of all ages, including those who are well into their adolescence. We describe the case of a 9-year old boy with an airway foreign body that had gone unrecognized for 3 months. We also review the literature on pediatric airway foreign bodies, with a focus on delayed diagnosis. A diagnosis of foreign body aspiration should be considered whenever a previously healthy child suddenly exhibits unexplained symptoms that are refractory to medical treatment and are consistent with airway obstruction.

We evaluated the validity and efficacy of a pediatric airway foreign body simulation for otolaryngology resident training. We created a course using a high-fidelity toddler mannequin designed to instruct and evaluate otolaryngology residents in pediatric airway foreign body management. Seven junior and 5 senior residents participated. Their performance was evaluated by 2 observers using an Objective Structured Assessment of Technical Skills (OSATS) instrument. By the third trial, all junior and senior residents scored a proficiency level of "independent without errors" or "independent and efficient," and the performance of the junior residents was not different from that of the senior residents. After completing the course, the junior residents self-rated their abilities as commensurate with those of a senior resident, and senior residents rated themselves capable of performing foreign body extraction without supervision. All participants felt that the course and simulator had good overall realism and a realistic feel, demonstrating face validity. Perhaps most importantly, the residents' highest ratings were for "facilitated management of complications" and "facilitated working with the operating room team"--areas difficult to teach during live surgical procedures. This pediatric airway foreign body course using a high-fidelity simulator has face and construct validity, and results in statistically improved performance and self-evaluation of all participants.

C-MAC® video-laryngoscope is often used by anesthetists in difficult intubation scenarios primarily in adults. Using this C-MAC® device in two of our pediatric cases, we successfully removed the laryngeal foreign body, while the anesthetist provided the apneic technique. A systematic review of PubMed and Google Scholar for similar cases was conducted. We found only one such case report of pediatric airway foreign body removal via video-laryngoscope in the English literature. The use of this high-quality, magnified video-laryngoscope in children in an emergency scenario is often not adequately applied. This procedure provides continuous real-time visualization to both the operating surgeon as well as the anesthetist in respect to the airway and thereby reduces the chance of any untoward complications. Here, we present two interesting case reports of C-MAC® video-laryngoscope assisted removal of laryngeal foreign body via apneic technique with spontaneous ventilation performed on two different children in our facility. Both these children had clinical symptoms of upper airway obstruction with fluctuating stridor simulating croup or asthma.