[Inhalation of foreign bodies: epidemiological data and clinical considerations in the light of a statistical review of 92 cases]

F Carluccio, R Romeo
Acta Otorhinolaryngologica Italica 1997, 17 (1): 45-51
In the present work 92 patients were studied all of whom had inhaled a foreign body (FB) into one of the tracheobronchial branch. The following factors were evaluated: sex, age, nature of the FB, localization in the respiratory tree, clinical symptoms, radiological findings, time lapse between diagnosis and removal. The peak incidence (61.9%) was in children under 3 years of age with a male-female ratio of 2:1. The most frequently inhaled FBs were of organic nature (31.5%); of these 58.6% were peanuts. The time lapse between inhalation and removal of the FB was as follows: in 20.5% the object was removed within 24 hours; in 66.4% within one week; in 12% in more than a week; and in 1.1% it took more than 8 weeks. In 53.2% of the cases the right bronchial branches were involved while in 28.2% the left side was affected. The most frequent symptoms were coughing (73.9%), wheezing (69.5%), dyspnea (51%) and fever (17.3%). Radiography detected the FB in only 7 cases (8.7%); in the remaining cases only indirect signs of the FB could be found: atelectasia (11.9%), emphysema (19.5%), cardio-mediastinic shift controlateral to the FB (10.8%). As regards complications, only 6 patients showed signs of slight endobronchial bleeding, 2 cases showed a pneumothorax and one other patient required a tracheotomy because of the particular shape of the FB which proved unable to pass backward through the glottis. In all cases the FB was removed using stiff bronchoscopy under either local or general anesthesia. The authors feel that, even if no clinical signs are found and radiography proves negative, one must always consider the possibility of a FB in the tracheal-bronchial branches, particularly in patients within the age range most at risk (under 3 years) and in those having a highly suspicious clinical history. In addition, the authors assert that the use of corticosteroids before and after the bronchoscopy markedly decreases the incidence of post-operative subglottic edema which would require an emergency tracheotomy.

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