A study on upper aerodigestive tract foreign bodies.

A foreign body is an endogenous or exogenous substance, incongruous with the anatomy of the site where it is found. Chevalier Jackson defined a foreign body as “an object or a substance that is foreign to its location”. Foreign body ingestion and aspiration can affect persons of any age, but the vast majority of these accidents occur in children under the age of five. It is estimated that 150 deaths occur annually in children, due to asphyxiation. Foreign bodies in the airway, pharynx and oesophagus continue to be a diagnostic and therapeutic challenge to practising otolaryngologists. Despite improvements in public awareness and emergency care, death due to aspiration is a leading cause of death in children. A high index of suspicion for foreign body aspiration or ingestion is needed, because a foreign body can mimic other medical conditions, particularly without a witnessed event. Hence there can be a delay in management that may lead to complications. According to the National safety council, suffocation from foreign body ingestion and aspiration is the third leading cause of accidental death in children younger than one year and the fourth leading cause in children between 1 and 6 years. Accidental ingestion or aspiration tends to be twice as common in boys4. In patients with multiple oesophageal foreign body impactions, 80 % have an oesophageal anomaly on further evaluation. When any patient gives a history of a foreign body, investigation is warranted regardless of their age or apparent absence of signs and symptoms. Rarely serious complications such as recurrent pneumonia, atelectasis, lung / retropharyngeal or mediastinal abscess, or massive hemorrhage due to a vascular fistula may occur before a thorough investigation is launched .In patients suspected of having ingested or aspirated a foreign object, appropriate x-rays are taken. Radiographs in airway foreign bodies are frequently normal in the first 24 hours after the initial event, but may become abnormal over time. The treatment of choice is prompt endoscopic retrieval. It is occasionally possible to retrieve a nasal, oropharyngeal or hypopharyngeal foreign body in a co-operative patient with only local anaesthesia. Rigid endoscopy has proven over time to be the safest and most efficacious therapy. In a total of 350 patients included in the study, 185 were males and 165 were females. Airway foreign bodies were 163 and 187 were in the digestive tract. Out of 163 objects, 43 were in the tracheobronchial passage, 120 were in the nasal cavity, which showed a higher incidence in children below 4 years. In general, aerodigestive foreign bodies were more common in children – 67% and in adults it was 33% only. Upper aerodigestive tract foreign bodies still remain a diagnostic challenge to health care professionals, despite technological advances. A high index of suspicion and early diagnosis are the key to successful and uncomplicated management of these accidents.