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Foreign Bodies in Pediatric Otorhinolaryngology: A Review
Ivan Paladin1, Ivan Mizdrak1, Mirko Gabelica1
1Department of ENT and Head and Neck Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia.
Insights
Foreign bodies (FBs) are common in young children, especially in the ears and nose. Prompt diagnosis and removal are crucial to prevent life-threatening airway obstruction and other serious complications.
Area of Science:
- Pediatric Otorhinolaryngology
- Emergency Medicine
- Foreign Body Ingestion/Aspiration
Background:
- Foreign bodies (FBs) constitute up to 10% of pediatric emergency department cases, predominantly affecting children under five.
- Curiosity and environmental exploration are primary drivers of FB incidents in children.
- Aural and nasal FBs are most frequent, with removal techniques varying by location and FB type (organic/inorganic).
Purpose of the Study:
- To review the incidence, common locations, and management strategies for foreign bodies in pediatric otorhinolaryngology.
- To highlight the diagnostic and therapeutic approaches for various FB presentations.
- To emphasize the critical importance of timely intervention in preventing severe outcomes.
Main Methods:
- Review of pediatric otorhinolaryngologic foreign body cases.
- Discussion of diagnostic modalities including radiology and direct visualization (bronchoscopy, esophagoscopy).
- Analysis of treatment strategies based on FB location (ear, nose, pharynx, tracheobronchial, esophagus).
Main Results:
- Pharyngeal FBs, such as fish bones in tonsils, are common.
- Laryngopharyngeal FBs pose an immediate life threat due to upper airway obstruction.
- Tracheobronchial aspiration is frequent in 1-4 year olds, indicated by coughing/choking.
- Rigid bronchoscopy is the gold standard for tracheobronchial FBs.
- Radiology aids esophageal FB diagnosis, with esophagoscopy for removal.
- Delayed diagnosis of tracheobronchial FBs can be fatal.
Conclusions:
- Effective management of pediatric foreign bodies requires prompt recognition and appropriate intervention.
- Timely diagnosis and treatment are paramount, particularly for tracheobronchial and laryngopharyngeal foreign bodies, to avert fatal consequences.
- A multidisciplinary approach involving emergency medicine and otorhinolaryngology is essential for optimal patient outcomes.
Abstract:
Foreign bodies (FBs) in pediatric otorhinolaryngology represent up to 10% of cases in emergency departments (ED) and are primarily present in children under five years old. They are probably the result of children's curiosity and tendency to explore the environment. Aural and nasal FBs are the most common and accessible, and the removal methods differ depending on the exact location and type of FB, which can be organic or inorganic. A fish bone stuck in one of the palatine tonsils is the most common pharyngeal FB. Laryngopharyngeal FBs can obstruct the upper respiratory tract and thus become acutely life-threatening, requiring an urgent response. Aspiration of FBs is common in children between 1 and 4 years old. A history of coughing and choking is an indication of diagnostic and therapeutic methods to rule out or confirm a tracheobronchial FB. Regardless of the availability of radiological diagnostics, rigid bronchoscopy is the diagnostic and therapeutic method of choice in symptomatic cases. Radiological diagnostics are more significant in treating esophageal FBs since most are radiopaque. Flexible or rigid esophagoscopy is a successful method of removal. A delayed diagnosis, as with tracheobronchial FBs, can lead to fatal consequences.
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