Foreign bodies in the nose causing complications and requiring hospitalization in children 0-14 age: results from the European survey of foreign bodies injuries study

INTRODUCTION: The occurrence of foreign bodies (FB) in otorhinolaryngological practice is a common and serious problem among pediatric patients. The aim of this work is to characterize the risk of complications and prolonged hospitalization due to FBs in the nose in terms of the characteristics of the injured patients (age, gender), typology and features of the FBs, the circumstances of the accident and the hospitalization's details. MATERIALS AND METHODS: A retrospective study of FB associated injuries, assessing the characteristics of the injured child and the FB, the circumstances of the accident and finally the hospitalization details took place on children aged 0-14 in major hospitals of 19 European countries. RESULTS: In total 688 cases were assessed. Complications and hospitalization occurred in 59 and 52 cases, respectively. Over 51% of patients were females. The median age of children who experienced a complication was four years. In the majority of cases FB removal was accomplished by means of a non-invasive technique (rhinoscopy with a nasal speculum or rigid fiberoptic endoscope. The majority of children were directly referred to the ENT department. The most common FBs associated with complications and hospitalization were nuts, seeds, berries, corn and beans, batteries and other inorganic objects such as broken parts of pens, paper clips and pearls. Over 38% of the injuries occurred under adults' supervision. DISCUSSION: FB injuries in the nose are commonly encountered in clinical practice. Even if the presence of a FB is not usually life threatening, it may result in long-term complications such as perforation of the septum. Because the risks associated with FB injuries, public education about this problem is recommended.     

Foreign bodies in the aerodigestive tract in pediatric patients

Objective: To investigate pediatric foreign body cases in the aerodigestive tract, and to elucidate the characteristic problems in Japan. Methods: A total of 310 pediatric patients (age 15 or below), gathered from two medical university hospitals (University of Tokyo and Jichi Medical School), were included in this study. Data were collected by retrospective chart review and were statistically analyzed. Results: Two-year-olds were the most common patients, and the range from age 1 to age 4 included 67.7% of all the patients. The most involved sites were the nose (39.4%) and the pharynx (38.4%), followed by the esophagus (12.9%) and the trachea-bronchi (6.5%). Fish bones and toys were the representative foreign bodies (30.7 and 13.6%, respectively). Other foreign bodies often encountered included coins, food, candy, peanuts and nuts, and batteries. The type of foreign body was closely related to the site in which foreign bodies were lodged: 77.3% of foreign bodies in the pharynx were fish bones, and toys were the most common impacted foreign body in the nose. In the esophagus, representative impacted foreign bodies were coins (35.7%), but disk-type battery ingestion has been increasing in recent years. Although most foreign bodies in the esophagus were safely removed, one case of a disk-type battery had a serious sequela. In the trachea-bronchi, peanuts, food, cotton, and coins were impacted. A rigid bronchoscope was basically used to remove foreign bodies, but in some cases, a fine flexible endoscope, with a channel for fiber forceps, was useful, because it could be inserted into narrow bronchi. Advance of a flexible endoscope will make it an excellent tool for diagnosis and management of the trachea-bronchial foreign body. Conclusions: Fish bones in the pharynx, which were closely related to Japanese eating habits, and toys in the nose, were the typical foreign bodies encountered in this study. In the esophagus, an increased incidence of disk-type battery ingestion has become a serious problem in recent years. Since prevention is the most essential way to manage foreign body cases, feedback from studies to public education should be encouraged.     

Foreign bodies of the nose and ears in children. Should these be managed in the accident and emergency setting?

OBJECTIVE: This study reviews the management of children with foreign bodies in the nose or ear in an attempt to see whether these children can be successfully managed in the Accident and Emergency (A & E) Department or whether they should be directly referred to the Otolaryngology service. METHODS: The records of all children with a foreign body in either the nose or ear who presented to the Accident and Emergency Department at The National Children's Hospital over a 2-year period were reviewed. RESULTS: 82 children presented with a foreign body in the nose and 53 (65%) were successfully managed in the A & E Department. In contrast, of the 58 children with a foreign body in the ear only 4 (7%) were successfully removed in the A & E Department. CONCLUSION: Most foreign bodies in the nose can be successfully removed in the Accident and Emergency Department. In contrast there is a high failure rate in removal of foreign bodies from the ear in the A & E Department and these should be referred directly to the ENT service.     

Foreign bodies in the ear,nose, and throat in Japan: association with sociocultural and geographical conditions

ObjectiveForeign bodies (FBs) in ear, nose, and throat (ENT) are common ENT emergencies but are sometimes life-threatening. However, FBs could be avoidable by the efficient announcement about the risk of these occurrence to the public. Fish bones are commonly found as throat FBs, and small toys are commonly found as pediatric ear and nose FBs. We hypothesized that there were relationships between the occurrence of FBs and sociocultural/geographical conditions. The purpose of this study is to clarify the risk factors of FBs in ENT regions related to eating customs and weather conditions.MethodsFrom April 2009 to March 2014, 94,479 patients visited the Chuo Emergency Clinic (CEC) in Osaka, which is a local emergency center for Osaka prefecture in Japan. Among them, 3229 patients with throat FBs, 577 children (0–15 years of age) with ear FBs, and 1999 children (0–15 years of age) with nose FBs were enrolled into the present study. Monthly trends in the number of throat FBs were examined in relation to fish eating customs. The monthly average of the daily ratio of pediatric patients with ear or nose FBs to the total number of patients were examined in relation to weather parameters using a database of the Japan Meteorological Agency.ResultsThe incidence of throat FBs was significantly higher in July and January (p < 0.05, analyzed by ANOVA and Tukey–Kramer test), presumably because Japanese people have more chances to eat fish in these months due to the traditional fish-eating customs. There was also a significant correlation between the number of pediatric patients with ear and nose FBs and the bad weather parameters including daily rainfall (r = 0.76, p = 0.0043; r = 0.57, p = 0.050, respectively, analyzed by the Pearson product-moment correlation coefficient). This is because children would spend longer time inside on rainy days, which increases the chance of putting a small toy part in the ear and nose.ConclusionsFBs in throat and ear/nose occurred more frequently in the specific periods to eat fish and rainy days, respectively. Therefore, public announcement on the risk of occurrence of FBs based on sociocultural and geographical data is helpful to prevent FBs.     

Foreign bodies in the upper airways causing complications and requiring hospitalization in children aged 0–14 years: results from the ESFBI study

Foreign body (FB) aspiration/inhalation is a serious problem because it is still a cause of death in children, especially among those younger than 4 years. The objective of this paper is to characterize the risk of complications and prolonged hospitalization due to foreign bodies (FB) in the upper airways in terms of the characteristics of the injured patients (age, gender), typology and features of the FBs, the circumstances of the accident and the hospitalization details. A retrospective study in the major hospitals of 19 European countries was realized on injuries occurred in the years 2000–2002 and identified by means of the International Classification of Diseases, Ninth Revision (ICD-9) codes listed on hospital discharge records. In 170 cases, it was reported an injury due to the presence of a FB in the pharynx and larynx (ICD933) and in 552 records, it was reported a FB located in the trachea, bronchi and lungs (ICD934). Unlike the complications that occurred in 70 (12.7%) of cases, the hospitalizations were present in 433 (77.6) of the total injuries. One patient died. A higher incidence in males (63%) was observed. Median age for children who experienced complications was 2 years. The most common FB removal technique was laryngoscopy and bronchoscopy. In majority of the cases, children were treated by ENT department. The most common FBs were nuts, seeds, berries, corn and beans. In general, small, round crunchy foods pose a risk of choking. Since prevention is the most essential key to deal with these types of injuries, more effort in caregivers’ public education is warranted.     

Ear and nose foreign body removal in children

The removal of foreign bodies in children is very common in the otolaryngologist's daily routine. We present a prospective series of 187 cases of ear and nose foreign bodies removed from children aged 0-12 years old in a 6-month period--95 females (50.8%) and 92 males (49.2%); 78 children (41.71%) aged from 1 to 2 years, 66 (35.29%) from 3 to 5 years. There were 93 cases (49.73%) of ear foreign bodies, in which a bean was the most common (24.73%), and 94 cases (50.27%) of nose foreign bodies, in which sponge fragments predominated (36.17%). In 82 cases (45.85%), the removal was performed within the first 24 h after the foreign body insertion, and 86 (45.98%) of the patients had previous attempts to remove it. Thirteen cases with complications (external ear canal lacerations, tympanic membrane perforation) were observed in patients in whom these previous attempts had been made, but there were no sequelae. This corresponds to one of the largest reports of ear and nose foreign body removal in children in the literature; we conclude that younger children are more prone to insert foreign bodies, which are objects usually found at home. Complications may occur as a result of attempts to remove the foreign body without the help of specialised personnel or proper conditions.     

Radiological diagnosis of aspirated foreign bodies in children: review of 343 cases

In our series of 400 Chinese children with foreign body aspiration (FBA), 343 cases were evaluated by fluoroscopy and/or plain chest X-rays before endoscopic removal of the foreign bodies. The majority of the foreign bodies (FBs) were organic (378/400, 94.5 per cent). The results showed that mainstem bronchial foreign bodies were diagnosed correctly in 68 per cent of cases compared with 65 per cent correct diagnoses with segmental bronchial foreign bodies, but only 22 per cent correct diagnoses with tracheal, and 0 per cent correct diagnosis in those with laryngeal foreign bodies. Eighty per cent (32/40) of the children with laryngotracheal FBs had normal X-ray findings, whereas 67.7 per cent (205/303) of the children with bronchial FBs had abnormal chest X-ray findings. The most common positive radiological signs in the children with tracheobronchial FBs were obstructive emphysema (131/213, 62 per cent) and mediastinal shift (117/213, 55 per cent). The incidence of major complications was related not only to the size of the foreign body and its location but also the duration since aspiration. The most common types of bronchial obstructions by airway FBs are discussed.     

Nasal foreign bodies in children

Between 1994 and 1997, a total of 72 nasal foreign bodies were removed from 68 children (28 girls and 40 boys, including 2 repeats) in the ENT Department at Robert Debré Hospital, Paris. Ages ranged from 1 to 12.5 years (median, 3 years) . Two children had bilateral foreign bodies. The unilateral foreign bodies were on the right side in 67.6% of cases. The most frequent objects were plastic objects, beads, paper, cotton and foam. Insertion was witnessed by an adult or reported by the child himself in the majority of cases. The other cases were diagnosed when complications occurred (as seen by persistent rhinorrhea and a foul body odor). All foreign bodies were removed in the consultation room using a hook or nasal forceps. Received: 21 July 1997 / Accepted: 28 October 1997     

Foreign bodies in the lower respiratory tract: experience based on materials gathered in the ENT department of the Poznań Higher School of Medical Sciences between 1945 and 1997

258 foreign bodies were removed from the lower respiratory tract in ENT Department of Poznań High School of Medical Sciences between 1945 and 1997. The age ranged from 0 to 85 years, but the most numerous group (68%) was found between 0 and 10 years. 86.5% patients were admitted to hospital during first three days after inserting the foreign body. The longest time of foreign body existence inside the bronchus was a period of 18 years. The most often met foreign bodies were: bones, bean seeds, fruit stones, pieces of food, iron nails. Spontaneous evacuation of the foreign body took place in 4% of cases. 98% of foreign bodies were removed by means of rigid bronchoscopy. Bronchofiberoscopy was performed for diagnostic purposes or for taking out foreign bodies located in the peripheral parts of the bronchial tree. 3% of patients were referred to the further toracosurgery treatment.     

ENT foreign bodies: profile of the cases seen at a tertiary hospital emergency care unit

Individuals often seek help with foreign bodies (FB) in their ears, noses, and throats. Proper recognition, study, and management of foreign bodies is required to prevent complications.ObjectiveTo analyze the profile of the patients seen for FB at a reference otorhinolaryngology emergency care unit between February of 2010 and January of 2011.MethodCross-sectional retrospective historical cohort study based on digitized patient charts.ResultsFB accounted for 827 cases and 5.3% of all patients seen in the ENT emergency unit. Children were affected more frequently, particularly when aged 8 and under. No statistically significant differences were seen between genders. Foreign bodies were mostly located in the ears (64.4%), followed by the nasal fossae (19.5%), and the oropharynx (8.9%). Complications were seen in 4.5% of the cases, and 4.4% required general anesthesia to have the FB removed.ConclusionIn our ENT practice, foreign bodies were more commonly seen in children; the ears were the preferential site of occurrence. Complication rates and use of general anesthesia were low in our practice. It should be stressed that ENT foreign bodies need to be properly managed so as to avoid complications.     

Positive pressure technique for removal of nasal foreign bodies

Nasal foreign bodies represent a common ENT problem in children. Ninety percent of these can be removed without otorhinolaryngologic intervention. Numerous documented techniques exist, employing instruments, which pose problems in children. Positive pressure technique avoids the need for instrumentation, therefore bypassing the disadvantages met by other techniques. Positive pressure technique is both safe and effective, highlighted by a success rate of 62.5% in 8 patients presenting acutely. Promising result of this small study warrantees further study in larger number of paediatric population. In contrast to previous documentation, children nursed prone tolerated the procedure better. Hollow objects were resilient to this technique and require other methods of removal. Positive pressure technique should be considered to remove foreign bodies from the paediatric nose especially in emergency department setting.     

The heterodox nature of "Turban Pins" in foreign body aspiration; the central anatolian experience

OBJECTIVE: The aim of this study is to determine the age and sex distribution and the nature of aspirated foreign bodies (FBs). We also compared Turban Pins (TP) with other FBs and discussed the extracting techniques. METHODS: From 1987 through 2006, 414 patients were managed and the records of the patients were retrospectively reviewed. RESULTS: Girls (56%) were influenced much more than the boys (44%). The median age was 4, however median age for girls and boys were 11 and 2, respectively. The 50% of the foreign body aspiration (FBA) were observed in the first years of life. There was also a great tendency to occur in the adolescent age group (32%), especially for girls. The most commonly aspirated foreign body was Turban pin (TP) (n=121) among 332 foreign bodies. FBs were successfully removed by rigid bronchoscopy in 94% of the patients. In patients who had a negative history (n=49), bronchoscopy was performed according to clinical suspicion, and it revealed foreign bodies in 41%. Thoracotomy was performed in eight (2.4%) patients. We had no mortality. CONCLUSIONS: These cases showed us that the type and age groups of FBA varies according to cultural conditions. We found that TP aspiration has different characteristics and it deserves a special attention. Suspicion is an important indication for bronchoscopy. We prefer rigid bronchoscopy because success rate is satisfactory.     

Foreign bodies in upper digestive tract

Foreign body ingestion is a common problem frequently encountered in both children and adults. A total number of 152 patients (104 children and 48 adults) with ingested foreign body admitted in our hospital are reviewed. Location of foreign body was made out by radiological examination. History of having swallowed foreign body was the most common symptom in both blunt and sharp foreign bodies. Endoscopic removal of foreign body was done under general anaesthesia for all cases, except one in which foreign body was removed by open surgical method. Blunt, foreign bodies were common among children, where as meat with bone was common in adults (19/48). Most of blunt foreign bodies in children (83.5%) were impacted in post cricoid region. Where as in adutls, the foreign bodies (37.5%) were seen in upper oesophagus. Retropharyngeal abscess was seen in 2 cases, which was associated with sharp foreign bodies. In all but one, endoscopic removal was successful. In one case denture impacted in post cricoid region was removed by open surgical method. There was no mortality in our series.     

A case of migratory fish bone in the thyroid gland

Fish-bone foreign bodies represent a common condition readily identified in the pharynx. We encountered a case of fish bone in the thyroid gland. Only three other such cases have been reported in the English-language literature. This foreign body was identified by computed tomography and ultrasonography 16 days after onset, and removed through a cervical skin incision. The diagnosis and treatment of extrapharyngeal foreign bodies are discussed.     

Inhalation of foreign bodies in chinese children: A review of 400 cases

A retrospective review of 400 Chinese children who had inhaled foreign bodies was undertaken. There has been a yearly increase in the total number of cases of airway foreign bodies removed in our hospital. Fifty-eight percent of the children presenting were from the countryside; 42% were townspeople. Approximately 90% of the patients were under 3 years of age, with the peak incidence of foreign body inhalation occurring between 1 and 2 years of age (57.8%). The male-female ratio was about 1.2:1. About 95% of the removed foreign bodies were organic in origin. The majority of the foreign bodies were found most often in the right bronchial tree (46%). A positive history of foreign body inhalation was obtained in 98% of the cases. Twenty-eight percent of the children presented at the hospital within 24 hours, 71% within 1 week, and 29% more than 1 week after inhaling the foreign body. The most common presenting symptoms of lar-yngotracheal foreign bodies were cough, wheezing, dyspnea, and hoarseness; those of bronchial foreign bodies were cough, wheezing, decreased air entry, and rhonchi. More than two-thirds of the children with laryngotracheal foreign bodies had normal x-ray findings. The most common fluoroscopic findings in those children with bronchial foreign bodies were mediastinal shift (36.8%), obstructive emphysema (35.7%), and normal findings (35%). A total of 348 (87%) bronchial foreign bodies were removed by rigid bronchoscopy (81%), rod-lens bronchoscopy (5%), and spontaneous expulsion (1%); 52 (13%) laryn-geal and tracheal foreign bodies were removed by direct laryngoscopy (12%) and tracheotomy (1%). A single endoscopic procedure successfully removed 92.5% of 400 foreign bodies detected in the airways. One child died during bronchoscopy, for a mortality rate of 0.25%.     

Otitis media with effusion in children and its correlation with foreign body in the external auditory canal

Otitis Media with Effusion (OME) is difined as the chronic accumulation of mucus within the middle ear and sometimes the mastoid air cell system. Significant hearing loss may go unnoticed and may result in improper development of speech and language. Foreign bodies in the external auditory canal of paediatric patients are commonly encountered in day-to-day practice. The purpose was to see if there is any relation between foreign bodies in ears and otitis media with effusion. A prospective study of consecutive cases was conducted between August 2005 and August 2007 at a teaching hospital. All children presenting with the history of a foreign body in the external auditory canal were included in this study. 50/74 that is 67.8% of the children in the study group had abnormal findings in the tympanogram whereas only 28/74 that is 37.8% children from the control group had abnormal findings in tympanogram. This study indicates that significant eustachian tube dysfunction to frank OME, causes irritation and/or earache in children which may compel them to put things into the ear. So children with an external auditory foreign body must be followed up in an ENT clinic. This may be an early opportunity to diagnose an underlying undetected OME and/or eustachian tube dysfunction in children, preventing the development of any complication from the undetected OME.     

Late diagnosis of foreign body aspiration in children with chronic respiratory symptoms

BACKGROUND: Children with undiagnosed and retained foreign bodies (FBs) may present with persistent respiratory symptoms. Delayed diagnosis is an important problem in developing countries and several factors affect the delay. OBJECTIVES: To investigate, the incidence of clinically unsuspected foreign body aspiration (FBA) in our flexible bronchoscopy procedures, the causes resulting in late diagnosis of FBA, and the incidence of the complications of FBA according to elapsed time between aspiration and diagnosis. METHODS: We reviewed the records of all the patients who underwent flexible bronchoscopy between 1997 and 2004 in our clinic. Patients with FBA were identified and their medical records were reviewed. RESULTS: During the study period, 654 children underwent flexible bronchoscopy; 32 cases (4.8%) of FBA were identified. Median age of patients was 29.5 months at presentation with a median symptomatic period of 3 months. None of the patients had a history of FBA. The most common misdiagnosis was bronchitis. Flexible bronchoscopy was performed to these patients within 1 week following presentation. In 87% of the patients (n=28), FBs were in organic nature. Patients were followed up for 21.0 months after removal of the FBs. Fifty-three percent (n=17) of the patients had a complete remission after bronchoscopic removal of the FBs. However, nine (28.8%) patients had chronic respiratory problems and six patients (18.8%) developed bronchiectasis. CONCLUSIONS: Atypical or prolonged respiratory symptoms should alert the physician and clinical and radiological findings should be carefully evaluated for a possible FBA. Delay in diagnosis and treatment of FBA should be avoided to prevent complications.     

Aspirated foreign bodies in pediatric patients, 1968-2010: a comparison between the United States and other countries

Objectives

To identify the most commonly aspirated airway foreign bodies (FBs) and identify opportunities for intervention.

Methods

Literature was searched and pertinent articles from 1968 to 2010 (n = 58; 14 articles were from the United States and 41 international) were reviewed. A list of the most commonly retrieved FBs resulted from the analysis.

Results

11,880 FBs were analyzed (1934 from the US and 9946 international, p < 0.0001). Food (edible) and food-related (inedible, e.g. bones) FBs were associated with most cases (68% in US and 84% internationally, p < 0.0001). In this category, most common in the US were: nuts (41%, 44% of which were peanuts), seeds (8%, 19% of which were sunflower seeds), vegetables (5%, 41.7% of which were carrots), popcorn (4%), and bones (2%). Internationally: nuts (37%, 76.9% of which were peanuts), seeds (29%, 32.7% of which were watermelon seeds), beans (7.8%), and bones (2%). Non-food sources were the source of FBs in 25% of US patients and 12% internationally (p < 0.0001). Of non-food sources, the most common FBs in US were: metallic (8%) and plastic (7%). Internationally: metallic (5%) and plastic (2%).

Conclusions

Most FB aspirations in pediatric patients occur while eating, with peanuts posing the greatest risk. The majority of FBs worldwide are nuts, seeds, and metallic objects. The significantly higher proportion of non-food FBs in the US may suggest that tighter regulation of products is needed. Educational or more stringent regulatory interventions should be considered to reduce FB aspirations from the sources highlighted herein.     

Bronchoscopic removal of foreign bodies from children in Bosnia and Herzegovina: experience with 230 patients

Objectives: To present the experience from an emerging country, in the bronchoscopic removal of foreign bodies in children. Methods: Retrospective analysis of medical records from 230 patients treated at the ENT Department, Tuzla University Hospital, Bosnia and Herzegovina, between January 1987 and December 1998. Results: Positive bronchoscopic findings were present in 136 (59.1%) cases. Right bronchus (53.7%) and left bronchus (30.1%) were the most frequent location of extracted foreign bodies. The types of extracted foreign bodies were organic in 114 (83.8%), non-organic in 12 (8.8%) and of an indefinite nature in ten (7.4%) cases. The most frequent type of foreign body was: pumpkin seed (23.4%), peanut (18.4%), bean (14.6%). The nature of the foreign body could not be determined in 7.4% cases: either because the foreign bodies were in the state of disintegration or were too small. Two children (0.87%) died during the bronchoscopy. Conclusion: Aspiration of foreign body into tracheobronchial tree in children carries a high risk although prompt treatment of survivors is associated with low mortality. Health care education is the key to prevention.     

Is routine histological examination of nasal polyps justified?

This study aims to assess the indications for histological examination of polypoid lesions removed from the nose. To achieve this we have performed a national survey of consultant ENT surgeons and reviewed 2866 nasal polypectomy operations. The operations were performed between 1982 and 1988 in the Radcliffe Infirmary, Oxford and the Freeman Hospital, Newcastle. One hundred and fifty questionnaires were sent to randomly selected ENT consultants in the United Kingdom. One hundred and seventeen were returned completed (return rate 78%). The questionnaire asked whether or not the surgeon sent all polyps for examination and, if not, what his indications were for so doing. A retrospective review of all nasal polypectomy operations at the two hospitals was performed. The questionnaire revealed that 38% of the surgeons who replied sent all nasal polyps for examination and 62% did not. The commonest indications for requesting histology were unilateral polyps, abnormal appearance and a history of bleeding. The review of polypectomies showed that 74% of cases in Oxford were examined histologically and 33% in Newcastle. Two per cent of polyps were tumours, of which half were malignant. There were no cases in this study in which unsuspected malignancy was found. All cases of nasal tumours, benign or malignant, were diagnosed clinically either in the Outpatient clinic or in the operating theatre. The results of this survey suggest that it is unnecessary to send all nasal polyps for histological examination.