Risk Of Foreign Body Aspiration Research Articles

TEP in the ER: After Hours Tracheoesophageal Prosthesis Management for the Otolaryngologist.

Tracheoesophageal voice puncture and prosthesis (TEP) is a common method of voice restoration following total laryngectomy. A variety of complications, both minor and major, can be associated with the TEP and require timely intervention/management. Some of those complications include premature leakage, periprosthetic leakage, granulation tissue growth, TEP dislodgement, or embedding of the TEP. Patients may present with problems and/or complications with the voice prosthesis in an emergency setting or after clinic hours when a trained speech pathologist is not present or readily available for evaluation and management. This manuscript aims to provide guidance for management of acute TEP complications to otolaryngology responders, especially those who may be less familiar with TEP troubleshooting. Experiential and literature review was undertaken by a group of head and neck specialized Speech Language Professionals in high volume Head & Neck Oncology practices, to develop consensus guidelines for emergency TEP management. TEP emergencies were categorized as (1) leakage through, (2) leakage around, (3) sudden loss of voicing, (4) loss of prosthesis, still in tract, (5) loss of prosthesis, not in tract. Management strategies for each form of emergency were developed to achieve patient safety and stability until definitive measures could be performed by the patient's Speech Language Professional. The goals of emergency management of TEP problems focused on minimizing risk of aspiration pneumonia, risk of foreign body aspiration, risk of wound complications at the puncture site. A simple management algorithm was developed for emergency or on-call otolaryngology responders.

TOOTH IN THE LUNG: CASE REPORT OF A TOOTH ASPIRATED DURING DENTAL EXTRACTION

TOOTH IN THE LUNG: CASE REPORT OF A TOOTH ASPIRATED DURING DENTAL EXTRACTION

A CASE OF RETAINED ORAL CARE SPONGE IN THE BRONCHUS CAUSING PNEUMONIA IN CHRONICALLY VENTILATED PATIENT

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Aspiration of foreign bodies is not uncommon and mostly accidental with the highest prevalence in young children [1]. Occurrence in adults is rare and usually as a result of diminished consciousness, sedation, trauma, and neuromuscular disorders. We present a case of a 70 year old patient receiving chronic mechanical ventilation who had multiple episodes of hypoxia due to a dislodged oral care sponge. CASE PRESENTATION: A 70 year-old bedbound male with chronic mechanical ventilation (via tracheostomy?) after traumatic brain injury, and recurrent pneumonia was admitted for pneumonia. On admission, respiratory cultures grew Carbapenem resistant Acinetobacter Bumanii and Pseudomonas Aeruginosa with negative urinalysis and blood cultures. Chest radiograph showed bilateral lower lobe opacities. He was treated with vancomycin, polymyxin B, and meropenem. However, his FiO2 fluctuated between 40% and 60% and despite being on antibiotics he was persistently febrile. He continued to have copious secretions requiring frequent suctioning without any new infiltrates on repeat chest radiograph. A Computer tomography (CT) of the chest was performed which showed a tubular structure extending from the right main bronchus to the bronchus intermedius (Image 1). Bronchoscopy was done and the object was found to be the head of an oral care sponge. After foreign body removal his respiratory status improved and fevers resolved. DISCUSSION: Oral care in mechanically ventilated patients has been studied extensively and there are many guidelines recommend to minimize ventilator associated pneumonia. Extreme care must be taken by providers as defective products or aggressive technique can result in fragments being dislodged into the oral cavity and can result in aspiration especially in patients with chronic tracheostomy. In patients with tracheostomy, diminished airway protective mechanisms and a deflated balloon can result in an increased risk of foreign body aspiration. Aspiration of a foreign body is a significant cause of morbidity as it can cause asphyxiation or trauma to the airway resulting in pneumothorax, bleeding, and infections [2]. In patients with diminished consciousness the signs of foreign body aspirations can be subtle such a mild cough, fevers, frequent infections, or increasing oxygen and they may not be able to provide a proper history. CONCLUSIONS: This case highlights the need for vigilance regarding potential complications from providing oral care in the elderly who have diminished ability to protect their airway. REFERENCE #1: 1. Ding G et al., Tracheobronchial foreign body aspiration in children: A retrospective single-center cross-sectional study. Medicine (Baltimore). 2020 May 29;99(22):e20480. REFERENCE #2: 2. Aissaoui, N. H. Salem, and A. Chadly, "Unusual foreign body aspiration as a cause of asphyxia in adults: an autopsy case report," The American Journal of Forensic Medicine and Pathology, vol. 33, no. 3, pp. 284–285, 2012. DISCLOSURES: No relevant relationships by Kabu Chawla, source=Web Response No relevant relationships by Varun tej Gonuguntla, source=Web Response Speaker/Speaker's Bureau relationship with pfizer Please note: $1001 - $5000 by Yizhak Kupfer, source=Admin input, value=Consulting fee No relevant relationships by Sharad Oli, source=Web Response No relevant relationships by kiran para, source=Web Response No relevant relationships by Ankur Sinha, source=Web Response

Selective laryngeal reinnervation for management of bilateral vocal cord paralysis

The surgical treatment of bilateral vocal fold paralysis should pro-vide patients with breathing comfort and adequate vocal function without the risk of foreign body aspiration. Bilateral selective la-ryngeal reinnervation appears to fulfill the above criteria while being an innovative method which opens up new horizons while not precluding the option of traditional static surgeries being car-ried out to expand the rima glottidis in cases of previous treatment failure. Proper selection of patients including detailed diagnostic tests is important for the success of the treatment. Selective rein-nervation of posterior cricoarytenoid muscles facilitates the ab-duction of vocal folds upon breathing. Reconstruction of the se-parate innervation of laryngeal muscles prevents the adduction of vocal folds upon inspiration while simultaneously preventing their atrophy and ensuring proper tension. Pulmonary function impro-vement is observed with good voice quality being maintained and no synkinesis being observed. However, selective laryngeal rein-nervation requires high precision and experience in the formation of microsurgical nerve anastomoses. Temporary tracheostomy is also required in patients. Transient aspiration may occur following the procedure and should be prevented. </br> </br> As seen from the cited studies, long-term follow-up results are favorable and bilateral selective laryngeal reinnervation should be included in the protocols for the management of patients with bilateral vocal fold paralysis.

Satisfaction with an In-House Nasal Foreign Body Removal Manikin: A Randomized Controlled Trial

IntroductionNasal foreign bodies can lead to life-threatening conditions. Hence, it is a necessity that physicians be well trained in the appropriate procedures for removal of nasal foreign bodies. However, training on real patients is not only unpractical it is also too dangerous, due to risk of foreign body aspiration during the procedure. Therefore, our goal was to construct a manikin, with a specific design, to serve all possible needs for training.MethodsWe developed an in-house manikin from 2 materials; these being flexible polyurethane foam and silicone. Silicone, which has elasticity similar to nasal alae, was used to develop the detachable nose and nasal cavity, whilst polyurethane foam, which is light and easy to carry, was used to develop the head. The in-house manikin was compared with a commercial manikin for satisfaction after a nasal foreign body removal procedure was performed in both groups, by 37 physicians, after conducting a randomized controlled trial with a crossover design.ResultsThe satisfaction scores of the in-house manikin were statistically significantly higher than the satisfaction scores of the commercial manikin for 6 dimensions: proper size, ease of use, ease of maintenance, flexibility of nasal alae relative to actual anatomy, similarity of the nasal cavity relative to actual anatomy and confidence that the manikin can upskill the medical students ability to practice on real patients (p value < 0.05).ConclusionThis in-house nasal foreign body removal manikin design had high satisfaction for training and could be used to develop further nasal foreign body removal manikins in the future.

Subcutaneous Emphysema in a Healthy Child: An Unusual Clue for the Diagnosis of Foreign Body Aspiration

Background: Spontaneous pneumomediastinum (SPM) and subcutaneous emphysema are rare findings in children. Various etiologies have been reported for SPM, such as foreign body aspiration in infants, especially in those aged less than three years. In addition to the complications associated with foreign body aspiration, SPM may also become a life-threatening condition if left untreated. In the present report, we discussed a case of subcutaneous emphysema, pneumothorax, and pneumomediastinum in a 13-month-old infant previously treated for pneumonia.Case report: The infant was initially presented with subcutaneous emphysema of the neck, without respiratory distress following pneumonia. In the chest radiography, mediastinal shift and possible pneumothorax were reported, and a chest tube was inserted as the respiratory condition deteriorated. Emergency bronchoscopy showed a foreign body logged in the left respiratory tract, which was removed. Three days later, the chest tube was detached, and the patient was discharged in healthy conditions within the next two days.Conclusion: Pediatricians constantly need to consider the risk of foreign body aspiration, particularly in the presence of respiratory complications, such as SPM, even in the infants with an unreliable history of foreign body aspiration

G84(P) Cultural risk of foreign body aspiration

Introduction Wearing a head scarf is practised by certain cultures and religions including Muslim females. The head scarf may be fixed using pins, there have been previous case reports and case series of accidental inhalation of scarf pins from countries where wearing head scarves is common, such as Egypt, Kuwait and Turkey. We present a case series from a city in the UK, of females with accidental scarf pin inhalation. Methods We searched for patients who had accidental scarf pin inhalation/indigestion presenting to a tertiary care Children’s Hospital emergency department and also those that were referred to the Acute Paediatric Department at a District General Hospital from January 2008 to December 2014. Results Over a 6 year period, a total of 12 patients presented with accidental scarf pin inhalation/ingestion. The age range of these patients ranged between 11 to 14 years, with a mean of 12.3 years. All were female Muslims, with no significant past medical history. The history given was that of the scarf pin was held in the mouth, and patients reported that they sneezed, were talking at the same time, laughing or were pushed by another person as a result of which they ingested or inhaled the pin. In 9 out of 12 of these patients, the x-ray’s showed that the pin was in the stomach, and 6 of these patients had a repeat x-ray to ensure that the pin had progressed within the GI tract. In two patients the pin was inhaled and was found to be in the left main bronchus and in one patient the pin was found to be in the upper airway on chest x-ray. All three patients required laryngotracheobronchoscopy and foreign body removal. Conclusion Health professionals working in a multi-cultural area need to be aware of this presentation and appropriate management. Wider educational measures are required in order to increase awareness regarding avoidance of placing the scarf pins in the mouth whilst placing head scarves.

Inhaled foreign bodies in a paediatric population at AKTH Kano-Nigeria.

Background:Inhaled foreign bodies are common paediatric emergencies and a major cause of accidental deaths at home among Nigerian children especially among children below the age of 5 years. Different types of foreign bodies have been reported from the ordinary to the most bizarre. We evaluated the types of foreign bodies and sites of possible impaction of these foreign bodies along the tracheobronchial tree.Materials and Methods:A 6-year case record of 35 patients with foreign body inhalation was reviewed from January 2005 to December 2010 at the Otorhinolaryngology Department of Bayero University/Aminu Kano Teaching Hospital, Kano — North-western Nigeria. Basic information such as date of birth, age groups, gender, indication for bronchoscopy, type of foreign bodies, sites of foreign body impaction and surgical outcome were extracted and analysed.Results:Thirty-five patients [18 (51.4%) males and 17 (48.6%) females, aged 6 months-10 years] with a mean age of 5.1 years and median of 5 years (+/- 3.0 Standard Deviation). The most affected age group with 31.4% is 3-5 years. Groundnuts and whistles were the most frequently inhaled foreign bodies with an equal frequency of 25.7%, respectively. Foreign bodies were preferentially lodged in the left main bronchus in 8 (22.9%) patients compared to the right main bronchus in 6 (17.1%) patients.Conclusion:Public enlightenment both in the news/print media on the risk of foreign body aspiration especially among the under-five's is highly advocated. The left main bronchus may be a common site for impaction as well.

A Study to assess the effectiveness of Planned Teaching Module Regarding Foreign Body Aspiration and its Prevention in Under-Five Children

A study was conducted in Heraklion, Crete, Greece to evaluate the effect of a campaign for proper education of the public on the risk of foreign body aspiration in children. A retrospective analysis of 87 endoscopic foreign body removal in children was performed at the department of Otorhinolaryngology during the period between January 2000 and December 2004. Results were compared with those of a previous study conducted during the period between 1991 and 1999. A foreign body was discovered in 44 cases, while in43 cases there were no findings. Both crude and age standardized bronchoscopy rates appear to be lower in the time period between 2000–2004 as compared to the time period prior to the educational program.8

Larinkste Ender Görülen Bir Yabancı Cismin Tanınmasında Fleksibl Laringoskobun Değeri: Dikenli Tohum (Xanthium Spinosum)

Foreign body aspiration is a common and dangerous problem among children of all ages. Children under the age of three carry the highest risk for foreign body aspiration. Some cases may present with less severe symptoms or a misleading history that result in a false diagnosis and confusion. The emergency room physician should seek the advice of an experienced otolaryngologist in a child with an acute airway problem regardless of the history and examination. In this article, we present an 8-month-old boy with supraglottic laryngeal foreign body detected by awake flexible laryngoscopy. The patient presented with a history of manual strangulation by his 5-year-old brother and had stridor, tachypnea and persistent cough. Awake flexible laryngoscopic examination in the office yielded prompt diagnosis in a patient with confusing history and presentation. Spiny cocklebur was removed from his larynx by direct laryngoscopy. The clinical presentation of the patient and his management are discussed.

Foreign body aspiration in children: the effects of delayed diagnosis

Background Foreign body aspiration is common in children, but there are no clinical clues that can determine or rule out the diagnosis before entering the operating room for bronchoscopy. The purposes of our study were to define the clinical characteristics of foreign body aspiration in the pediatric population and to evaluate the significance of delay in its diagnosis and treatment. Methods and results The study used a retrospective review of 136 charts of children up to the age of 16 who underwent bronchoscopy for foreign body removal for 10 years in Ha'Emek Medical Center (Afula, Israel). An adult witness of an aspiration episode (most frequent presenting symptom), a child younger than 2 years, and an abnormal plain chest radiography were found to be significant predictors of foreign body aspiration. Estimated risk for foreign body aspiration was significantly higher in children who were younger than 2 years with an eyewitness for the aspiration episode and abnormal chest radiography (odds ratio, 5.6, with confidence interval from 2.0 to 15.6). The rate of complication was 2-fold higher in patients who arrived at the hospital 2 days or more after the aspiration compared with patients who arrived earlier. The rate of complication was 2-fold higher in patients who underwent bronchoscopy 24 hours or more after arrival at the emergency department compared with patients who underwent bronchoscopy within the first 24 hours. Conclusion Delayed arrival of a child with a suspected foreign body aspiration at the hospital and delayed bronchoscopy were found to be related to a higher rate of complication.

Manufacturing defect in an endotracheal tube connector: risk of foreign body aspiration

Manufacturing defect in an endotracheal tube connector: risk of foreign body aspiration

The risk of foreign body aspiration in children can be reduced with proper education of the general population

To evaluate the effect of a campaign for proper education of the public on the risk of foreign body aspiration in children. A retrospective analysis of 87 endoscopic foreign body removals in children was performed at the Department of Otorhinolaryngology, Head and Neck Surgery of the University Hospital of Crete, during the period between January 2000 and December 2004. Results were compared with those of a previous study conducted by the same Department during the period between 1991 and 1999. A foreign body was discovered in 44 cases, while in 43 cases there were no findings. Twenty-one foreign bodies (47.73%) were found in the right main bronchus, 20 foreign bodies (45.45%) were found in the left main bronchus and 3 (6.82%) in the trachea. Both crude and age-standardized bronchoscopy rates appear to be lower in the time period 2000-2004, as compared to the time period prior to the educational program. The decline in the total number of bronchoscopies during recent years has been a result of a campaign for proper education of the public and especially parents, caretakers and families. All aspects of the educational campaign are described in detail. The risk of high morbidity and mortality from foreign body aspiration makes it mandatory to increase even more the awareness of the general population.

Mysterious Mediastinal Object

Mysterious Mediastinal Object

Clinical characteristics of aero-digestive foreign bodies in neurologically impaired children

Objective: To determine if children with neurological impairment are at additional risk for foreign body aspiration or impaction and if they present with a different clinical course than normal children. Design: Retrospective cohort study. Setting: Tertiary care children's hospital. Patients and other participants: A retrospective chart review of 328 consecutive procedures for aero-digestive foreign body removal over a 6 year period was performed. Of these patients 52 (15.9%) were identified with neurological impairment. Results: Compared with the non-impaired children, those with neurological impairment were older, diagnosed later, hospitalized longer and had a higher incidence of complications. Conclusion: A greater index of suspicion is needed to timely treat aero-digestive foreign bodies in children with neurological impairment. These children may not be receiving the necessary attention when presenting with non-specific symptoms.