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Laryngeal foreign bodies in children revisited
Robert G Berkowitz1, Wye-Keat Lim
1Department of Otolaryngology, Royal Children's Hospital, and University of Melbourne, Melbourne, Australia.
Insights
Delayed diagnosis of inhaled laryngeal foreign bodies in children can lead to complications. Prompt endoscopic evaluation is crucial for effective management and improved outcomes in pediatric airway emergencies.
Area of Science:
- Pediatric Otolaryngology
- Emergency Medicine
- Pediatric Airway Management
Background:
- Inhaled laryngeal foreign bodies pose a significant risk to children.
- Timely diagnosis and intervention are critical for preventing airway obstruction and associated morbidity.
Purpose of the Study:
- To review institutional experience with pediatric inhaled laryngeal foreign bodies.
- To identify factors associated with delayed diagnosis and complications.
Main Methods:
- Retrospective review of pediatric admissions with laryngeal foreign bodies (March 1989-March 2002).
- Inclusion criteria: diagnosis confirmed by endoscopy under general anesthesia.
- Exclusion criteria: cases not undergoing endoscopy (e.g., expired on arrival).
Main Results:
- Nine pediatric cases identified (age range: 5 months to 13 years 9 months).
- Foreign body removal within 24 hours in 4 children with witnessed choking.
- Delayed diagnosis (4 days to 2 months) in 5 children, including 2 with initially missed choking history.
- One complication (laryngeal edema requiring intubation) occurred in a delayed diagnosis case.
Conclusions:
- Delayed diagnosis of laryngeal foreign bodies in children increases complication risk.
- Endoscopic confirmation is essential for accurate diagnosis.
- Early recognition and intervention improve pediatric airway foreign body outcomes.
Abstract:
To review our experience with inhaled laryngeal foreign bodies in children, we performed a retrospective review of all admissions to our institution between March 1989 and March 2002 with the diagnosis of an inhaled laryngeal foreign body. We included only cases in which the diagnosis was confirmed at endoscopy under general anesthesia. Two children were dead on arrival at our institution as a result of upper airway obstruction following a choking episode and did not undergo endoscopy; they were not included. Nine children (5 male, 4 female) were identified. The age range was 5 months to 13 years 9 months, although only 1 child was older than 32 months. The foreign body was removed within 24 hours of a witnessed choking episode in 4 children, and the diagnosis was delayed in 5 children for a period between 4 days and 2 months, including 2 in whom a history of a choking episode had been initially obtained. One complication occurred in a child in whom the diagnosis was delayed; he developed laryngeal edema after foreign body removal and required endotracheal intubation for 1 week.