Laryngo-Tracheo-Bronchial Foreign Bodies: Indication For Endoscopic Evaluation Of Sudden Or Persistent Respiratory Symptoms

Abstract

Background: Inhalation or aspiration of foreign bodies especially in children, poses diagnostic and therapeutic endoscopic challenges mainly because of high mortality rate if not identified and treated immediately.
Materials and Methods: This is a retrospective study of clinical pattern of laryngeal and tracheo-bronchial foreign bodies over an eight year period (July 1999 to June 2007) from a tertiary health institution in north western Nigeria.
Results: A total number of 23 patients were seen with inhalational or aspirated foreign bodies. Nine (39.13%) were lodged in the larynx, one (4.34%) in the trachea while 13(56.52%) were lodged in the bronchus. There were 19 males (82.6%) and 4 females (17.4%) with a male to female ratio of 4.8:1.Their ages ranged between 7months and 9years with a mean age of 2.9years. Fifteen of the patients (65.2%) were less than 5years old. Organic or vegetative foreign bodies (78.3%) such as agricultural seeds accounted for 56.5%, followed by fish and meat bones (17.4%). The commonest clinical presentation was sudden respiratory distress with recurrent bouts of cough (100%).The duration of symptoms varied from a few hours to 9 days. Direct laryngoscopy and rigid bronchoscopy were carried out for impacted laryngeal and bronchial foreign bodies. Tracheostomy was carried out in 4(17.4%) patients to relieve airway obstruction before endoscopy.
Only 14(60.9%) patients had a positive history of foreign body inhalation or aspiration and in 13(56.5%) cases foreign body was detected radiologically or showed radiologically changes highly suspicious of foreign body impaction. Mortality was recorded in two (8.7%) patients with bronchial foreign bodies.
Conclusion: Inhalational or aspirated foreign bodies mainly affected children with a mean age of 2.9 years in this study and presented with sudden episodes of severe respiratory distress or persistence of respiratory symptoms requiring endoscopic evaluation and removal without which will be fatal. Organic or vegetative objects such as agricultural seed, fish and meat bones were the commonest laryngo-tracheo-bronchial foreign bodies should always be excluded where there is persistent respiratory symptoms or if it is of sudden onset.

Keywords: Foreign body, Larynx, Trachea, Bronchus, Rigid endoscopy

Sahel Medical Journal Vol. 11 (3) 2008: pp. 97-101