© Borgis - New Medicine 4/2009, s. 102-103
Mieczysław Chmielik, *Jolanta Jadczyszyn
FOREIGN BODIES IN LOWER AIRWAYS IN CHILDREN TREATED IN THE PAEDIATRIC OTOLARYNGOLOGY CLINIC OF THE MEDICAL UNIVERSITY OF WARSAW IN 2005-2009
Department of Paediatric Otorhinolaryngology, Medical University of Warsaw, Poland
Head of Department: Prof. Mieczysław Chmielik, MD, PhD
Introduction: Foreign bodies in lower airways in children are present there mainly by accident. Most frequently when children are from 1 to 3 years old. A foreign body in airways poses a direct threat to life, so each child with such a suspicion should be hospitalised. Bronchoscopy is the method of choice in treatment.
Aim: To analyse case histories of children treated in 2005-2009 in the Paediatric ENT Clinic in Warsaw.
Material and method: The case histories analysed are those of children treated in the last 5 years in the Paediatric ENT Department of the Medical University of Warsaw. The age of the children ranged from 6 months to 16 years.
Results: The majority of hospitalised children with a foreign body in airways were not older than 3.5 years. In 59% of cases a foreign body was detected in males. The most frequent foreign body was peanuts (56.7%).
Conclusions: Bronchoscopy should be administered in each case of a suspicion of presence of a foreign body in airways. If no foreign body is found on one side, bronchoscopy should be administered on the other side.
Foreign bodies in lower airways in children are present there mainly by accident. While children play, they put them into their mouths, and subsequently during abrupt movements, eating, simultaneous laughing, or talking they lose control and aspirate (1). Foreign bodies in airways are present mainly in children who are from 1 to 3 years old. They are rarely present in the larynx, more often in the trachea and bronchi. Any object having a size not exceeding the inside diameter of the larynx may become a foreign body (2). While foreign bodies in the alimentary tract may be naturally excreted, foreign bodies in lower airways have no such possibility. Their spontaneous expectoration rarely happens. Despite progress in treatment, they still pose a direct threat to life, and if they remain in lower airways for a longer time they cause irreversible bronchi and lung reactions (3). In each case of aspiration of a foreign body into lower airways and in the case of a suspicion of aspiration, endoscopic bronchoscopy should be administered.
The aim was to analyse case histories of children admitted in the Paediatric Otolaryngology Clinic of the Medical University of Warsaw in 2005-2009 with suspicion of aspiration of a foreign body into lower airways. The foreign bodies removed were described and kept for educational purposes.
The study covered 94 cases with suspicion of aspiration of a foreign body into lower airways - larynx, trachea, or bronchi. 53 boys and 33 girls were hospitalised. The age of the children analysed ranged from 6 months to 16 years. The average age was 4 years.
The following aspects were analysed: age, gender, initials of the patients, circumstances of aspiration, occurrence of symptoms, duration of retention of the foreign bodies, performed examinations, endoscopic treatments, location of the foreign bodies, presence of granulation tissue, and complications. Auscultatory symptoms in paediatric examination and duration of the children´s stay in hospital were taken into account.
Presence of a foreign body in airways was detected in 30 children. The age of the children ranged from 14 months to 14 years and 3/12. The majority of children hospitalised were not older than 3.5 years (66.7%). A foreign body was more often detected in males (59%). No foreign body was detected in 64 cases and no spontaneous expectoration of a foreign body was observed.
The most frequently detected foreign bodies in lower airways were as follows: peanuts (56.7%), small plastic objects (16.6%), pieces of food - carrot (6.6%), pins (6.6%). The following objects were detected in single cases: a bone, a pin, a pumpkin seed, a needle (in total 13.6%). Location of a foreign body depended on its shape and size. Among 30 foreign bodies, the majority were removed from the right main bronchus (60%). 4 foreign bodies (a bone, a needle, 2 plastic objects) were removed from the trachea, 18 foreign bodies (13 peanuts, 2 pieces of carrot, 2 small plastic parts, 1 pill) were removed from the right bronchial tree, 8 foreign bodies (2 pins, 4 peanuts, 1 piece of plastic, 1 pumpkin seed) were removed from the left bronchial tree.
The period of retention of foreign bodies in lower airways ranged from 10 hours (needle in the trachea) to 1 month (peanut in the right main bronchus).
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