Airway foreign bodies in children: diagnostic and treatment

The aim of study: To evaluate the results of endoscopic diagnostics and treatment of pediatric patients with respiratory tract foreign bodies (FB). Materials and methods. From 2001 to June 2024, 248 patients with suspected FBs aged 7 months to 15 years (average age 2.5 years) were examined and treated. The highest number of aspirated FBs occurred in patients under five years of age, with the peak incidence occurring between the ages of 1 and 2 years. Boys predominated in a ratio of 1.98:1. The duration of suspected FB aspiration ranged from 1 hour to 1.5 years. Results. Pathological changes according to X-ray were detected in more than 50% of patients. Among them, the prevalence of pulmonary tissue swelling and atelectasis (78 - 31.45%), which is an indirect sign of the presence of FB in the respiratory tract. X-ray contrast FB were detected in 14 (5.64%) patients. FB of organic origin were detected in more than 80% of patients. In 145 (60.92%) cases, these were sunflower peel and seeds, peanuts, and legume seeds. X-ray contrast FB (14 - 5.88%) were metal objects. An attempt at FB extraction was performed in all patients. The technical success of the intervention was 98.73% (235 patients). In most cases - 186 (78.15%) aspirated FB (especially in young children) were extracted by using rigid tracheobronchoscopy. The technique of combined tracheobronchoscopy for FB extraction (used in 49 (20.58%) patients) was optimal for this category of patients: a flexible bronchoscope was inserted through the rigid bronchoscope tube, which made it possible to combine the advantages of both methods. FBs from the lower respiratory tract were successfully extracted by using flexible bronchoscopy in 52 (21.84%) patients. Conclusions. The frequency of FB detection in pediatric patients admitted to hospital is very high. Most foreign bodies in pediatric patients are of organic origin. Endoscopic methods are the main ones in the diagnosis and treatment of pediatric patients with foreign bodies in the respiratory tract, allowing for foreign body extraction in more than 98.9% of cases. Flexible endoscopes can be used at the diagnostic stage. The choice of equipment at the FB removal stage depends on the specialist’s experience (flexible endoscope only, rigid endoscope, combination of flexible and rigid bronchoscope).

foreign bodies of the respiratory tract, bronchoscopy, rigid bronchoscopy, children, removal of foreign body

1. Gayen G. C., Das D., Ray R., Maitra M. Management of Tracheo-Bronchial Foreign Bodies in Children: Our Experience. Indian J Otolaryngol Head Neck Surg. 2022;74(4):536-539. doi: 10.1007/s12070-022-03098-x.

2. Brkic F., Umihanic S., Altumbabic H. et al. Death as a Consequence of Foreign Body Aspiration in Children. Med Arch. 2018;72(3):220-223. doi: 10.5455/medarh.2018.72.220-223.

3. Sultan T. A., van As A. B. Review of tracheobronchial foreign body aspiration in the South African paediatric age group. J Thorac Dis. 2016 Dec;8(12):3787-3796. doi: 10.21037/jtd.2016.12.90.

4. Rodríguez H., Passali G. C., Gregori D. et al. Management of foreign bodies in the airway and oesophagus.Int J Pediatr Otorhinolaryngol. 2012;76 Suppl 1: S84-91. doi: 10.1016/j.ijporl.2012.02.010.

5. Salih A. M., Alfaki M., Alam-Elhuda D. M. Airway foreign bodies: A critical review for a common pediatric emergency. World J Emerg Med. 2016;7(1):5-12. doi: 10.5847/wjem.j.1920-8642.2016.01.001.

6. Cohen S., Goldberg S., Springer C., Avital A., Picard E. Foreign body aspiration in children. Harefuah. 2015;154(3):175-7, 211.

7. Sink J. R., Kitsko D. J., Georg M. W., Winger D. G., Simons J. P. Predictors of Foreign Body Aspiration in Children Otolaryngol Head Neck Surg. 2016;155(3):501-7. doi: 10.1177/0194599816644410.

8. Johnson K., Linnaus M., Notrica D. Airway foreign bodies in pediatric patients: anatomic location of foreign body affects complications and outcomes Pediatr Surg Int. 2017;33(1):59-64. doi: 10.1007/s00383-016-3988-9.

9. Woo S. H., Park J. J., Kwon M., Ryu J. S., Kim J. P. Tracheobronchial foreign body removal in infants who had very small airways: A prospective clinical trial Clin Respir J. 2018;12(2):738-745. doi: 10.1111/crj.12586.

10. Hitter A., Hullo E., Durand C., Righini C. A. Diagnostic value of various investigations in children with suspected foreign body aspiration: review. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128(5):248-52. doi: 10.1016/j.anorl.2010.12.011.

11. Rusetsky Yu.Yu., Spiranskaya O.A., Chernyshenko I.O. Foreign bodies at the lower respiratory tract in children: contemporary diagnostic and therapeutic approaches. Pediatriya. Zurnal im. G. N. Speranskogo. 2015;94(4):30-35. (In Russ.) @@ Русецкий Ю. Ю., Спиранская О. А., Чернышенко И. О. Инородные тела нижних дыхательных путей у детей: современные диагностические и лечебные подходы. Педиатрия. Журнал им. Г. Н. Сперанского. 2015; 94(4):30-35.

12. Kim K., Lee H. J., Yang E. A., Kim H. S., Chun Y. H., Yoon J. S., Kim H. H., Kim J. T. Foreign body removal by flexible bronchoscopy using retrieval basket in children. Ann Thorac Med. 2018;13(2):82-85. doi: 10.4103/atm.ATM_337_17.

13. Sheehan C. C., Lopez J., Elmaraghy C. A. Low rate of positive bronchoscopy for suspected foreign body aspiration in infants Int J Pediatr Otorhinolaryngol. 2018;104:72-75. doi: 10.1016/j.ijporl.2017.10.030.

14. Holst-Albrechtsen S., Kristensen S., Larsen K. Bronchoscopy in children suspected of lower airway aspiration Dan Med J. 2017;64(11). pii: A5419.

15. Ding G., Wu B., Vinturache A., Cai C., Lu M., Gu H. Tracheobronchial foreign body aspiration in children: A retrospective single-center cross-sectional study. Medicine (Baltimore). 2020;99(22): e20480. doi: 10.1097/MD.0000000000020480.

16. Hegde S. V., Hui P. K., Lee E. Y. Tracheobronchial foreign bodies in children: imaging assessment Semin Ultrasound CT MR. 2015;36(1):8-20. doi: 10.1053/j.sult.2014.10.001.

17. Amer H. S., El-Anwar M.W., Raafat A., AlShawadfy M., Sobhy E., Ahmed S. A., Maaty A. M. Laryngo-Tracheo-Bronchial Foreign Bodies in Children: Clinical Presentations and Complications. Iran J Otorhinolaryngol. 2017;29(92):155-159.

18. Ünal G., Yılmaz A. İ., Tok T., Pekcan S. Use of Flexible Bronchoscopy in Foreign Body Aspiration. Turk Arch Otorhinolaryngol. 2022;60(2):88-94. doi: 10.4274/tao.2022.2022-6-6.