Indian Pediatrics 2000;37: 193-195
Foreign Body Aspiration:Manipal Experience
Bhavana B. Lakhkar, Pushpa Kini, Vijaya Shenoy and Nalini Bhaskaranand
From the Department of Pediatrics, Kasturba Medical College, Manipal, Karnataka, India.
Reprint requests: Dr. B.B. Lakhkar, 144 K.M.C. Campus, Manipal, Karnataka 576 119, India.
Manuscript received: February 15, 1999;
Initial review completed: April 22, 1999;
Revision accepted: August 18, 1999
The well known habit of children to place objects in mouth frequently leads to impaction of foreign body in tracheobronchial tree. It is one of the leading causes of accidental home deaths in children under 6 years. This study analyses clinical manifestations, radiological features, complications, management and long term effects of foreign body inhalations in children.
Subjects and Methods
Case records of 97 children aged between 6 months to 15 years who presented with foreign body aspiration between January 1987 to December 1996 were evaluated. The presenting history, clinical signs, complications, radiological findings and treatment was noted. Followup varied from 1 to 9 years. At follow up evidence of complications were sought and if needed X-rays were taken. Pulmonary function tests were done in those who completed 5 years after foreign body removal and were above 5 years of age. Predicted and measured VC, fVC and FEV were noted.
Age ranged between 6 months and 15 years and 52% were in 1-3 years age group. The male to female ratio was 1.6:1. A history of foreign body aspiration was present in 86.5% of cases. Seventy per cent presented within 48 hours and rest between 1 week to 1 month.
Cough (79.4%), breathlessness (53.6%) and choking (43%) were other common symptoms, Only 13.5% had recurrent respiratory infections or clinical and radiological findings. Children with foreign bodies in larynx or trachea presented with stridor and hoarseness of voice. The most common clinical and radiological findings were obstructive emphysema (30%) followed by collapse and collapse consolidation. In these cases the foreign body was lodged for a long time. In 7.5% cases foreign body was radio-opaque.
Bronchoscopy was done in 96 children. In 67% it was done within 48 to 72 hours , in 20% the interval was 1 week and in the remaining it ranged between 1 month to 2 years. One child coughed out the foreign body. In majority rigid bronchoscope was used, in two fibreoptic bronchoscope was used due to peripheral deposition of foreign body. When foreign body removal was within 24 hours no bronchoscopic abnormality was found in 85.7% except mucosal congestion. With delay in removal, changes like granulation tissues, gush of purulent fluid, collapse and bronchiectatic changes were seen.
Seventy six per cent of foreign bodies were of vegetable type and peanuts were the commonest (44%) followed by Tamarind seeds (16%). Metal coins were other types of foreign bodies (30.4%). The right bronchus was the most common site (44.8%) while, left bronchus foreign body was seen in 40.6%. Complications (Table I), were more with vegetable foreign body. Hypoxic encephalopathy was the most severe early complication.
Table I__Complications of Foreign Body
Figures in parentheses represent percentages.
Twelve percent needed repeat bronchoscopy due to persistence of symptoms or radiological findings. Fifty four percent had fragments left. No surgical intervention was needed.
Thirty five children came for followup. Only one had recurrent respiratory tract infections. In 19 cases pulmonary function test was done as they were above 5 years and was normal. Out of these 9 had radiological changes at presenta-tion, 2 had hypoxic encephalopathy and 1 had laryngeal edema.
An increased frequency of foreign body in 1-3 years age group was noticed by us and also by others(1,2). This is probably due to im-maturity of mechanism co-ordinating swallow-ing and respiration. Male preponderance was also noticed by others(2,3). The cause could not be explained.
No history of foreign body aspiration was available in 14% of cases. Bronchoscopy in these subjects done due to other signs and symptoms revealed a foreign body. This shows the importance of high index of suspicion. Hoeve et al.(4) who studied the diagnositc value of signs and symptoms due to foreign body found choking and coughing to be very sensitive features (81% and 71%) but their specificity was low. Obstructive emphysema and collapse were most common clinical and X-ray findings in other studies also(1_3). Sensitivity of Chest X-ray for diagnosis is described to be 82% and specificity increases by taking both inspiratory and expiratory films(4). Peanut was the most common foreign body found by others also(1,2) but Kruk et al.(5) found bones to be most common. This variation is related to food habits of the community studied.
Spontaneous evacuation has been docu-mented by others also(5). Rigid bronchoscopy was used in all above studies except one(5) where like us fiberoptic bronchscope was used for diagnosis or for peripheral foreign body. The duration between foreign body insertion and removal appears to be main factor responsible for bronchoscopic changes and complications as shown in this and other studies. Late complications were seen with vegetable foreign body as they not only increase in size but also cause chemical reaction with bronchial secretions.
As foreign body is known to cause perma-nent damage to lungs, pulmonary function tests were done at follow up. Unfortunately, all the cases with severe complications could not be followed up which may explain recording of normal test results in our study.
We conclude that foreign body aspiration is a preventable accident which can be fatal also. Proper supervision of feeding and play activities of children will help in reducing its occurrence.
1. Wolach B, Raz A, Weinberg J. Aspirated foreign bodies in the respiratory tract of children: Eleven years experience with 127 patients. Int J Pediatr Otorhinolaryngol 1994; 30: 1-10.
2. Gerbaka B, Azar J, Rassi B. Foreign bodies of the respiratory tract in children. A retrospective study of 10 cases. J Med Liban 1997; 45: 8-10.
3. Lis G, Kobylarz K, Cichocka JE, Krysta M, Mroze KB. Foreign bodies in respiratory tract of children treated at the Institute of Pediatrics in Krakow during the years 1987-1991. Przegl-Lek 1992; 49: 399-402.
4. Hoeve LJ, Rombout J, Pot DJ. Foreign body aspiration in children. The diagnostic value of signs and symptom and prepoerative examina-tion. Clin Otolaryngol 1993; 18: 55-57.
5. Kruk Zagajewka A, Szemeza Z, Wojtowicz, Wierzbicka M, Piatkowski K. Foreign body in lower respiratory tract: Experience based on material gathered in ENT Department of Poznam highschool of Medical sciences between 1945 and 1997. Otolaryngol Pol 1998; 52: 683-688.