aspirated foreign bodies in children: why are they more commonly found on the left?

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Aspirated foreign bodies in children: why are they more commonly found on the left? M.A.J. VAN LOOIJ, P.P.M. ROOD, L.J. HOEVE & J.A. BORGSTEIN Department of ENT, Erasmus MC Rotterdam, the Netherlands Accepted for publication 10 February 2003 VAN LOOIJ M . A . J ., ROOD P. P. M ., HOEVE L . J . & BORGSTEIN J . A . (2003) Clin. Otolaryngol. 28, 364±367 Aspirated foreign bodies in children: why are they more commonly found on the left? The objective was to present our experience in the brochoscopic removal of foreign bodies in children. This was carried out through a retrospective analysis of the medical records of 96 patients in whom endoscopic removal of an inhaled foreign body was required, at the department of paediatric otorhinolaryngology, Eramus Medical Centre, Rotterdam. The participants were all children who underwent bronchoscopy after suspected foreign body aspiration from 1990 to 2000. The main outcome measures were con®rmed diagnosis of foreign body aspiration and localization of aspirated foreign body. It was seen that in children up to 3 years of age, there was no signi®cant difference in foreign body distribution and in children aged 3 and older foreign bodies were more commonly found in the right main bronchus. It was concluded that aspirated foreign bodies are equally distributed between the left and right main bronchus in children younger than 3 years. This could be explained by the handling of choking infants by their parents. Keywords foreign body bronchial localization infants Choking on foreign bodies, including food, is a common life- threatening emergency. In the US, choking on foods is the sixth most common cause of accidental death. 1 Young chil- dren are at risk especially for several reasons: because of lack of a complete set of teeth they are not able to chew as well as adults; young children have a tendency to put things in their mouths and they often cry with a full mouth. 2 Symptoms which should raise suspicion of an inhaled foreign body are: coughing, dyspnoea, choking, wheezing, pain in the chest, cyanosis, haemoptysis and fever. Cataneo et al. described that only 1.4% of their patients displayed no symptoms at all. 3 Radiologically also children differ from adults; whereas atelectasis is less frequently seen, air trapping is much more common 4 and radiographs should always be taken both during inspiration and expiration. Methods We reviewed the medical records of all the patients with a suspected foreign body in the airways, admitted to the Sophia Childrens Hospital in Rotterdam over a period of 10 years (1990±2000). In 96 cases, one or more foreign bodies were found in either one or both the main bronchi during broncho- scopy, these cases were included in our study. Surgical reports were also reviewed. We analysed the cases for gender, age, localization and type of foreign body. Statistical analysis was carried out using SPSS for windows version 10.0. Results Foreign body aspiration occurred signi®cantly more in boys than in girls; 67.7% and 32.3%, respectively (binomial test, P 0.001) (Fig. 1). The highest incidence of foreign body aspiration was in 1- year-old children (46.9% of all cases), followed by 2-year olds (18.8%). Incidents in children aged 3 and older was sporadic (Fig. 2). In children up to 3 years of age, there was no signi®cant difference in distribution (left/right bronchi) where the foreign body was found (binomial test P 0.625). In children aged 3 and older, foreign bodies were more frequently found in the right main bronchus (binomial test, P 0.003) (Figs 3±6). Foreign bodies were more frequently found in the left main bronchus in young children than in older children (w 2 0.003). 65.6% of aspirated foreign bodies found were all varieties of Clin. Otolaryngol. 2003, 28, 364±367 364 # 2003 Blackwell Publishing Ltd Correspondence: Dr Johannes Borgstein, University Hospital Rotterdam, Dr Molewaterplein 60 (Sp1417), 3015 GJ Rotterdam, the Netherlands (e-mail: [email protected]).

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