Clinical evaluation of foreign body aspirations in childhood

Background: Foreign body aspiration (FBA) is one of the major causes of childhood morbidity and mortality worldwide. Early respiratory distress; in the late period, it may cause complications such as obstructive emphysema, atelectasis, lung abscess, empyema, bronchiectasis, pneumothorax. Sudden death may occur with the escape of a large foreign body into the trachea and complete obstruction of the respiratory tract; a small foreign body can also cause hypoxia, again resulting in death, by causing laryngospasm. Aim: In our study, we aimed to examine the demographic data, examinations, medical treatments, bronchoscopy information and length of hospital stay of patients who were evaluated by rigid bronchoscopy due to foreign body aspiration. Materials and Methods: In our study, epidemiological / demographic data, laboratory investigations, medical / surgical treatments and prognosis information of the patients who applied to the Dokuz Eylül University Medical Faculty Pediatric Emergency Service between March 2010 and March 2020 due to foreign body aspiration were analyzed retrospectively. Results: Thirty six percent of the patients were found to be female and sixty four percent were male. The male / female ratio was seen as 1,8. The average age is 30.4 ± 31.7 months. Witnessed aspiration history was reported in 56% of the patients. It was seen that the witnessed aspiration history was the most important part of the anamnesis in foreign body aspiration. 59 (94%) of the foreign bodies that were removed and whose type was specified were organic and 4 (6%) were inorganic. The most common finding in postero-anterior chest radiography was found to be increased ventilation with 51%. It was seen that 41% of the patients applied on the same day. A moderate positive correlation was observed between the time from the onset of suspected foreign body aspiration symptoms to bronchoscopy and the duration of hospital stay (r: 0,522 p <0.001). The most common physical examination finding was decreased respiratory sounds (59%). When the differences in physical examination findings between the FB (+) and FB (-) groups in bronchoscopy were examined, the decrease in respiratory sounds was found as a statistically significant parameter. In our study, the most common foreign body was seen in the right main bronchus and its branches. Granulation tissue was observed in 5 patients (6%) in our study. The relationship between the time from aspiration to bronchoscopy and the formation of granulation tissue was found to be significant (p=0,004). Of those included in the study, 58% needed ventolin and 28% inhaled steroids in the perioperative period. Conclusion: Rigid bronchoscopy should not be delayed for diagnosis and treatment, especially in the high-risk age group (1-3 years), if there is a decrease in cough and respiratory sounds in the presence of a person witnessing aspiration. Postero-anterior chest radiography is not sufficient to exclude foreign body aspiration. Delay in diagnosis increases the formation of granulation tissue due to foreign body and the rate of complications. Since organic foreign body aspiration (nuts) is common, especially in the younger age group, nutrition should be followed carefully. Key words: Foreign body aspiration, Rigid bronchoscopy, Childhood