bs_bs_banner
doi:10.1111/jpc.12673
ORIGINAL ARTICLE
Ear, nose and throat foreign bodies: The experience of the Pediatric Hospital of Turin Giancarlo Pecorari,1 Paolo Tavormina,2 Giuseppe Riva,1 Vincenzo Landolfo,2 Luca Raimondo1 and Massimiliano Garzaro1 1
Surgical Sciences Department, University of Turin, 1st ENT Division and 2Regina Margherita Pediatric Hospital, Pediatric ENT Division, Turin, Italy
Aim: Ear, nose and throat (ENT) foreign body (FB) injuries represent an emerging problem in the paediatric population because of their human and social costs. The aim of the study is the site-specific evaluation of FB injuries in the paediatric population referred to the emergency department of the Pediatric Hospital of Turin. Methods: This retrospective analysis was carried out sifting medical reports between 2002 and 2011. We collected information about 338 patients’ FB characteristics, complications and hospitalisation. Results: The mean age was 4.2 ± 2.9 years. Nose and ear are the most involved anatomical sites, followed by pharynx, oesophagus and trachea-bronchi. The most common FBs are balls, beads and toys parts (29.6%), followed by fishbones (13.6%). A lower mean age is observed in tracheo-bronchial and oesophageal FBs. The 9.2% of cases reported complications. Conclusions: A quick and proper diagnosis followed by an effective treatment of FB injuries and their complication is mandatory. Surveillance registries have a key role in prevention and management of FB injuries; useful information can be obtained also for nurse and ENT specialist training in order to create professionals ready to recognise and manage FB injuries in the most effective way. Key words:
foreign bodies; paediatric hospital; otorhinolaryngologic disease; ingestion; inhalation.
What is already known on this topic
What this paper adds
1 Ear, nose and throat foreign body injuries represent an emerging problem because of their human and social costs. 2 Consequences vary from death to lower impact disturbances with or without hospitalisation. 3 In the last decades, online and easily accessible medical record networks were created.
1 This paper evaluated foreign body injuries in the paediatric population according to their anatomical location. 2 This paper evaluated foreign body complications and hospitalisation. 3 Correlations between patients and foreign bodies characteristics were analysed.
In the last decades, an apparent increased number of ear, nose and throat (ENT) foreign bodies (FBs) has been observed and it is probably justified by the creation of online and easily accessible medical record networks. Several research groups started investigating this topic because FBs were raised as a public health concern, both for the costs on the injured children and their families’ quality of life and for their socio-economic impact.1–3 Unintentional and intentional injuries, caused by fire and burns, suffocation, drowning, firearms, falls, choking and poisoning,4 are the second leading determinant of health-care expenditure3 and the young children group is one at higher costs.5 Correspondence: Dr Giuseppe Riva, Surgical Sciences Department, University of Turin, 1st ENT Division, Via Genova 3, Turin 10126, Italy. Fax: +39 011 633 66 50; email: [email protected] Conflict of interest: The authors declare that they have no conflict of interest. Accepted for publication 20 May 2014.
978
A particular subset of injuries is related to the inhalation/ aspiration, ingestion or insertion of FBs in the upper aerodigestive ways or in the external auditory canal (EAC). A large survey carried out by Iwata et al. in paediatric patients showed that in the Tokai area of Japan, the most common oesophageal, tracheal and bronchial FBs were coins, fishbones, food, toys and peanuts, with an estimated prevalence rate of 0,882 cases/ 100 000 people for oesophageal FBs and of 1084 cases/100 000 people for tracheal or bronchial FBs.6,7 Young children, in particular between 1 and 3 years, more than adults, are exposed to FB injuries because of their mouthing activity, which has been clearly stated as an important component in childhood development.8,9 As children develop, mouthing behaviour, in combination with looking and touching, allows them to explore and investigate their environment.10–12 Another explanation for mouthing is teething: sucking and chewing objects alleviate the pain and discomfort associated with teeth eruption.10 Mouthing activities vary significantly from one child to another, and therefore, FB injury incidence can be highly variable.13
Journal of Paediatrics and Child Health 50 (2014) 978–984 © 2014 The Authors Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
G Pecorari et al.
Foreign bodies in otorhinolaryngology
Consequences of FB injuries vary from death to lower impact disturbances with or without hospitalisation. This variability is referred to several factors such as FBs’ chemical composition, shape and dimensions, but also to the characteristics of the anatomical district involved. The aim of this retrospective analysis is the evaluation of FB injuries in the paediatric population referred to the emergency department of the Pediatric Hospital of Turin, recording and analysing characteristics of patients and FBs.
Methods This retrospective analysis was carried out sifting medical reports of the emergency department stored using the TrakCare software (InterSystem Corporation, Cambridge, MA, USA) between 2002 and 2011. Inclusion criteria were as follows: completely filled patient’s forms; diagnosis of FBs based on ENT physical examination, rigid or flexible fiber optic rhinopharyngo-laryngoscopy and/or tracheo-bronchoscopy and/or oesophago-gastroscopy, sometimes integrated by pharyngeal and oesophageal imaging; no neuropsychiatric diseases. From each record, we collected information about patient’s age, sex, comorbidities, urban versus non-urban address and about the characteristics of FBs such as location, type, shape, consistency and dimensions. Moreover, we recorded the occurrence of complications and hospitalisation (permanence in hospital for one night or more). All persons gave their informed consent prior to their inclusion in the study. University of Turin Review Board approval was obtained. FB location was classified according to International Classification of Diseases (ICD)9-CM code:14 ears (ICD931), nose (ICD932), pharynx and larynx (ICD933), trachea, bronchi and lungs (ICD934) and mouth, oesophagus and stomach (ICD935). Moreover, Rimmell et al.’s classification was used in order to characterise pharyngeal, laryngeal and oesophageal FBs.15 All statistical analyses were carried out using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 17.0. A detailed descriptive analysis of all data was performed. The Pearson chi-square test was used to compare percentages and frequencies. For all analyses, P-values 2 cm FBs’ shape Spherical 3D 2D 2D circle Sharp FBs FBs’ consistency Rigid Semi-rigid Conforming FBs’ type Organic Inorganic Setting at time of accident Playing Eating
Ears (100 patients) (%)
Nose (103 patients) (%)
Pharynx (48 patients) (%)
Trachea, bronchi and lungs (46 patients) (%)
Mouth and oesophagus (41 patients) (%)
5.4 ± 3.5
3.8 ± 2.3
5.5 ± 3.2
2.9 ± 1.1
2.6 ± 2.0
61 (61.0) 39 (39.0)
55 (53.4) 48 (46.6)
28 (58.3) 20 (41.7)
30 (65.2) 16 (34.8)
17 (41.5) 24 (58.5)
100 (100.0) 0 (0.0) 0 (0.0)
93 (90.3) 10 (9.7) 0 (0.0)
20 (41.7) 28 (58.3) 0 (0.0)
41 (89.1) 5 (10.9) 0 (0.0)
25 (61.0) 16 (39.0) 0 (0.0)
21 (21.0) 69 (69.0) 9 (9.0) 1 (1.0) 4 (4.0)
28 (27.2) 57 (55.4) 4 (3.8) 14 (13.6) 6 (5.8)
0 (0.0) 47 (97.9) 0 (0.0) 1 (2.1) 47 (97.9)
23 (50) 23 (50) 0 (0.0) 0 (0.0) 10 (21.7)
1 (2.4) 26 (63.4) 0 (0.0) 14 (34.2) 9 (21.9)
70 (70.0) 17 (17.0) 13 (13.0)
81 (78.6) 13 (12.7) 9 (8.7)
47 (97.9) 1 (2.1) 0 (0.0)
45 (97.8) 1 (2.2) 0 (0.0)
39 (95.2) 0 (0.0) 2 (4.8)
10 (10.0) 90 (90.0)
13 (12.6) 90 (87.4)
47 (97.9) 1 (2.1)
20 (43.4) 26 (56.6)
6 (14.6) 35 (85.4)
90 (90.0) 10 (10.0)
75 (72.8) 28 (27.2)
1 (2.1) 47 (97.9)
16 (34.8) 30 (65.2)
17 (41.4) 24 (58.6)
FB, foreign body.
980
Journal of Paediatrics and Child Health 50 (2014) 978–984 © 2014 The Authors Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
G Pecorari et al.
Table 2
Foreign bodies in otorhinolaryngology
Symptoms and signs of FBs
Symptoms and signs Ears (100 patients) Hearing loss Ear fullness Otalgia Itching Otorragia Asymptomatic patients Nose (103 patients) Nasal obstruction Nasal pain Cacosmia Rhinorrhea Epistaxis Asymptomatic patients Pharynx (48 patients) Sore throat Odynophagia FB sensation Asymptomatic patients Trachea, bronchi and lungs (46 patients) Cough Wheeze Dyspnoea Cyanosis Haemoptysis Dysphonia Thoracic pain Asymptomatic patients Mouth and oesophagus (41 patients) Pain Dysphagia Sialorrhea Nausea Vomiting Haematemesis Asymptomatic patients
n of patients (%)
34 (34.0) 53 (53.0) 30 (30.0) 9 (9.0) 0 (0.0) 31 (31.0) 34 (33.0) 27 (26.2) 55 (53.4) 29 (28.1) 2 (1.9) 58 (56.3) 39 (81.3) 46 (95.8) 15 (31.3) 0 (0.0) 30 (65.2) 21 (45.6) 13 (28.2) 2 (4.3) 2 (4.3) 1 (2.1) 3 (6.5) 0 (0.0) 20 (48.8) 8 (19.5) 14 (34.1) 27 (65.9) 12 (29.2) 2 (4.9) 1 (2.4)
Fig. 3 Age distribution of FBs in ears (ICD931), nose (ICD932), pharynx (ICD933), trachea, bronchi and lungs (ICD934), and mouth and oesophagus (ICD935). FB, foreign body; ICD, International Classification of Diseases.
FB, foreign body.
Pharynx (48 cases) Pharyngeal FBs were mainly localised in oropharynx, only a coin was found in nasopharynx of a patient, while hypopharynx was not involved. In oropharyngeal localisation, 23 FBs (49%) were observed in right tonsil, 21 (45%) in the left one and 3 (6%) in the base of the tongue. The most frequently removed type of FB was fishbone (92%). No complications were observed, but hospitalisation was required in six cases (12.5%) after surgical removal performed using Kelly forceps.
Trachea, bronchi and lungs (46 cases) Among 46 cases of inhaled FBs, multiple objects were observed in 15% of cases. In one patient, the FB was located in the
trachea (2%), in 28 cases it was in the right main or lobar bronchus (61%), in 16 cases in the left main or lobar bronchus (35%) and in one case (2%), multiple and bilateral FBs were observed. The most frequently removed FBs were nuts and peanuts (43%). Two injuries were caused by the inhalation of a battery. We recorded two cases of acute bronchopneumonia and three cases of acute dyspnoea with death in two cases due to delay in diagnosis and treatment. FBs were removed during operative tracheo-bronchoscopy under general anaesthesia by means of forceps; all patients were hospitalised.
Mouth and oesophagus (41 cases) In 36 patients, FBs were located in oesophagus, in five cases in the mouth and no FBs were found in the stomach. Among oesophageal FBs, 1 (2.8%) was spherical, 21 (58.3%) were 3D and 14 (38.9%) were 2D circle; their consistency was rigid in 34 cases (94.4%) and conforming in 2 cases (5.6%).
Journal of Paediatrics and Child Health 50 (2014) 978–984 © 2014 The Authors Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
981
Foreign bodies in otorhinolaryngology
G Pecorari et al.
Only seven objects (19.4%) were sharp. The maximum dimension of these objects was lesser than 1 cm in 20 cases (55.6%) and between 1 and 2 cm in 16 cases (44.4%). In 31 cases (86.2%), FB composition was inorganic; organic ones were found in 5 cases (13.8%). The most frequently removed FBs were coins (36% of cases); in three patients, injuries were caused by the ingestion of a battery. Oral cavity FBs were located in the hard palate in four cases (80.0%); all objects were 3D and had rigid consistency and four objects (80.0%) were sharp. No FBs greater than 1 cm in maximum dimension were observed. In one case (20.0%), the FB was organic; in two cases (40.0%), it was a battery. FBs were removed during oropharyngoscopy (by means of forceps), operative oesophagoscopy or open oesophageal surgery; two cases of haematemesis due to sharp FBs were recorded: one of them was caused by oesophageal perforation. Patients who underwent oesophagoscopy in general anaesthesia were hospitalised. Analysing FB location and children age, a lower mean age is observed in tracheo-bronchial and oesophageal FBs, whereas auricular, nasal and pharyngeal localisations were recorded in older children (P < 0.05). Collecting and analysing data about FBs location and setting of the adverse event, we observed that among older children (age >3 years), there is a statistically significant correlation (P < 0.05) between site and setting: children commonly insert FBs in ears and nasal cavities while playing, conversely such objects frequently can be inhaled or dug into the pharynx or oesophagus while eating. Moreover, we observed a statistically significant correlation between age and pharyngeal FBs location: in older children (age >3 years), the most frequently removed FBs were fishbones because of the change in food composition. In younger children (age
doi:10.1111/jpc.12673
ORIGINAL ARTICLE
Ear, nose and throat foreign bodies: The experience of the Pediatric Hospital of Turin Giancarlo Pecorari,1 Paolo Tavormina,2 Giuseppe Riva,1 Vincenzo Landolfo,2 Luca Raimondo1 and Massimiliano Garzaro1 1
Surgical Sciences Department, University of Turin, 1st ENT Division and 2Regina Margherita Pediatric Hospital, Pediatric ENT Division, Turin, Italy
Aim: Ear, nose and throat (ENT) foreign body (FB) injuries represent an emerging problem in the paediatric population because of their human and social costs. The aim of the study is the site-specific evaluation of FB injuries in the paediatric population referred to the emergency department of the Pediatric Hospital of Turin. Methods: This retrospective analysis was carried out sifting medical reports between 2002 and 2011. We collected information about 338 patients’ FB characteristics, complications and hospitalisation. Results: The mean age was 4.2 ± 2.9 years. Nose and ear are the most involved anatomical sites, followed by pharynx, oesophagus and trachea-bronchi. The most common FBs are balls, beads and toys parts (29.6%), followed by fishbones (13.6%). A lower mean age is observed in tracheo-bronchial and oesophageal FBs. The 9.2% of cases reported complications. Conclusions: A quick and proper diagnosis followed by an effective treatment of FB injuries and their complication is mandatory. Surveillance registries have a key role in prevention and management of FB injuries; useful information can be obtained also for nurse and ENT specialist training in order to create professionals ready to recognise and manage FB injuries in the most effective way. Key words:
foreign bodies; paediatric hospital; otorhinolaryngologic disease; ingestion; inhalation.
What is already known on this topic
What this paper adds
1 Ear, nose and throat foreign body injuries represent an emerging problem because of their human and social costs. 2 Consequences vary from death to lower impact disturbances with or without hospitalisation. 3 In the last decades, online and easily accessible medical record networks were created.
1 This paper evaluated foreign body injuries in the paediatric population according to their anatomical location. 2 This paper evaluated foreign body complications and hospitalisation. 3 Correlations between patients and foreign bodies characteristics were analysed.
In the last decades, an apparent increased number of ear, nose and throat (ENT) foreign bodies (FBs) has been observed and it is probably justified by the creation of online and easily accessible medical record networks. Several research groups started investigating this topic because FBs were raised as a public health concern, both for the costs on the injured children and their families’ quality of life and for their socio-economic impact.1–3 Unintentional and intentional injuries, caused by fire and burns, suffocation, drowning, firearms, falls, choking and poisoning,4 are the second leading determinant of health-care expenditure3 and the young children group is one at higher costs.5 Correspondence: Dr Giuseppe Riva, Surgical Sciences Department, University of Turin, 1st ENT Division, Via Genova 3, Turin 10126, Italy. Fax: +39 011 633 66 50; email: [email protected] Conflict of interest: The authors declare that they have no conflict of interest. Accepted for publication 20 May 2014.
978
A particular subset of injuries is related to the inhalation/ aspiration, ingestion or insertion of FBs in the upper aerodigestive ways or in the external auditory canal (EAC). A large survey carried out by Iwata et al. in paediatric patients showed that in the Tokai area of Japan, the most common oesophageal, tracheal and bronchial FBs were coins, fishbones, food, toys and peanuts, with an estimated prevalence rate of 0,882 cases/ 100 000 people for oesophageal FBs and of 1084 cases/100 000 people for tracheal or bronchial FBs.6,7 Young children, in particular between 1 and 3 years, more than adults, are exposed to FB injuries because of their mouthing activity, which has been clearly stated as an important component in childhood development.8,9 As children develop, mouthing behaviour, in combination with looking and touching, allows them to explore and investigate their environment.10–12 Another explanation for mouthing is teething: sucking and chewing objects alleviate the pain and discomfort associated with teeth eruption.10 Mouthing activities vary significantly from one child to another, and therefore, FB injury incidence can be highly variable.13
Journal of Paediatrics and Child Health 50 (2014) 978–984 © 2014 The Authors Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
G Pecorari et al.
Foreign bodies in otorhinolaryngology
Consequences of FB injuries vary from death to lower impact disturbances with or without hospitalisation. This variability is referred to several factors such as FBs’ chemical composition, shape and dimensions, but also to the characteristics of the anatomical district involved. The aim of this retrospective analysis is the evaluation of FB injuries in the paediatric population referred to the emergency department of the Pediatric Hospital of Turin, recording and analysing characteristics of patients and FBs.
Methods This retrospective analysis was carried out sifting medical reports of the emergency department stored using the TrakCare software (InterSystem Corporation, Cambridge, MA, USA) between 2002 and 2011. Inclusion criteria were as follows: completely filled patient’s forms; diagnosis of FBs based on ENT physical examination, rigid or flexible fiber optic rhinopharyngo-laryngoscopy and/or tracheo-bronchoscopy and/or oesophago-gastroscopy, sometimes integrated by pharyngeal and oesophageal imaging; no neuropsychiatric diseases. From each record, we collected information about patient’s age, sex, comorbidities, urban versus non-urban address and about the characteristics of FBs such as location, type, shape, consistency and dimensions. Moreover, we recorded the occurrence of complications and hospitalisation (permanence in hospital for one night or more). All persons gave their informed consent prior to their inclusion in the study. University of Turin Review Board approval was obtained. FB location was classified according to International Classification of Diseases (ICD)9-CM code:14 ears (ICD931), nose (ICD932), pharynx and larynx (ICD933), trachea, bronchi and lungs (ICD934) and mouth, oesophagus and stomach (ICD935). Moreover, Rimmell et al.’s classification was used in order to characterise pharyngeal, laryngeal and oesophageal FBs.15 All statistical analyses were carried out using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 17.0. A detailed descriptive analysis of all data was performed. The Pearson chi-square test was used to compare percentages and frequencies. For all analyses, P-values 2 cm FBs’ shape Spherical 3D 2D 2D circle Sharp FBs FBs’ consistency Rigid Semi-rigid Conforming FBs’ type Organic Inorganic Setting at time of accident Playing Eating
Ears (100 patients) (%)
Nose (103 patients) (%)
Pharynx (48 patients) (%)
Trachea, bronchi and lungs (46 patients) (%)
Mouth and oesophagus (41 patients) (%)
5.4 ± 3.5
3.8 ± 2.3
5.5 ± 3.2
2.9 ± 1.1
2.6 ± 2.0
61 (61.0) 39 (39.0)
55 (53.4) 48 (46.6)
28 (58.3) 20 (41.7)
30 (65.2) 16 (34.8)
17 (41.5) 24 (58.5)
100 (100.0) 0 (0.0) 0 (0.0)
93 (90.3) 10 (9.7) 0 (0.0)
20 (41.7) 28 (58.3) 0 (0.0)
41 (89.1) 5 (10.9) 0 (0.0)
25 (61.0) 16 (39.0) 0 (0.0)
21 (21.0) 69 (69.0) 9 (9.0) 1 (1.0) 4 (4.0)
28 (27.2) 57 (55.4) 4 (3.8) 14 (13.6) 6 (5.8)
0 (0.0) 47 (97.9) 0 (0.0) 1 (2.1) 47 (97.9)
23 (50) 23 (50) 0 (0.0) 0 (0.0) 10 (21.7)
1 (2.4) 26 (63.4) 0 (0.0) 14 (34.2) 9 (21.9)
70 (70.0) 17 (17.0) 13 (13.0)
81 (78.6) 13 (12.7) 9 (8.7)
47 (97.9) 1 (2.1) 0 (0.0)
45 (97.8) 1 (2.2) 0 (0.0)
39 (95.2) 0 (0.0) 2 (4.8)
10 (10.0) 90 (90.0)
13 (12.6) 90 (87.4)
47 (97.9) 1 (2.1)
20 (43.4) 26 (56.6)
6 (14.6) 35 (85.4)
90 (90.0) 10 (10.0)
75 (72.8) 28 (27.2)
1 (2.1) 47 (97.9)
16 (34.8) 30 (65.2)
17 (41.4) 24 (58.6)
FB, foreign body.
980
Journal of Paediatrics and Child Health 50 (2014) 978–984 © 2014 The Authors Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
G Pecorari et al.
Table 2
Foreign bodies in otorhinolaryngology
Symptoms and signs of FBs
Symptoms and signs Ears (100 patients) Hearing loss Ear fullness Otalgia Itching Otorragia Asymptomatic patients Nose (103 patients) Nasal obstruction Nasal pain Cacosmia Rhinorrhea Epistaxis Asymptomatic patients Pharynx (48 patients) Sore throat Odynophagia FB sensation Asymptomatic patients Trachea, bronchi and lungs (46 patients) Cough Wheeze Dyspnoea Cyanosis Haemoptysis Dysphonia Thoracic pain Asymptomatic patients Mouth and oesophagus (41 patients) Pain Dysphagia Sialorrhea Nausea Vomiting Haematemesis Asymptomatic patients
n of patients (%)
34 (34.0) 53 (53.0) 30 (30.0) 9 (9.0) 0 (0.0) 31 (31.0) 34 (33.0) 27 (26.2) 55 (53.4) 29 (28.1) 2 (1.9) 58 (56.3) 39 (81.3) 46 (95.8) 15 (31.3) 0 (0.0) 30 (65.2) 21 (45.6) 13 (28.2) 2 (4.3) 2 (4.3) 1 (2.1) 3 (6.5) 0 (0.0) 20 (48.8) 8 (19.5) 14 (34.1) 27 (65.9) 12 (29.2) 2 (4.9) 1 (2.4)
Fig. 3 Age distribution of FBs in ears (ICD931), nose (ICD932), pharynx (ICD933), trachea, bronchi and lungs (ICD934), and mouth and oesophagus (ICD935). FB, foreign body; ICD, International Classification of Diseases.
FB, foreign body.
Pharynx (48 cases) Pharyngeal FBs were mainly localised in oropharynx, only a coin was found in nasopharynx of a patient, while hypopharynx was not involved. In oropharyngeal localisation, 23 FBs (49%) were observed in right tonsil, 21 (45%) in the left one and 3 (6%) in the base of the tongue. The most frequently removed type of FB was fishbone (92%). No complications were observed, but hospitalisation was required in six cases (12.5%) after surgical removal performed using Kelly forceps.
Trachea, bronchi and lungs (46 cases) Among 46 cases of inhaled FBs, multiple objects were observed in 15% of cases. In one patient, the FB was located in the
trachea (2%), in 28 cases it was in the right main or lobar bronchus (61%), in 16 cases in the left main or lobar bronchus (35%) and in one case (2%), multiple and bilateral FBs were observed. The most frequently removed FBs were nuts and peanuts (43%). Two injuries were caused by the inhalation of a battery. We recorded two cases of acute bronchopneumonia and three cases of acute dyspnoea with death in two cases due to delay in diagnosis and treatment. FBs were removed during operative tracheo-bronchoscopy under general anaesthesia by means of forceps; all patients were hospitalised.
Mouth and oesophagus (41 cases) In 36 patients, FBs were located in oesophagus, in five cases in the mouth and no FBs were found in the stomach. Among oesophageal FBs, 1 (2.8%) was spherical, 21 (58.3%) were 3D and 14 (38.9%) were 2D circle; their consistency was rigid in 34 cases (94.4%) and conforming in 2 cases (5.6%).
Journal of Paediatrics and Child Health 50 (2014) 978–984 © 2014 The Authors Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
981
Foreign bodies in otorhinolaryngology
G Pecorari et al.
Only seven objects (19.4%) were sharp. The maximum dimension of these objects was lesser than 1 cm in 20 cases (55.6%) and between 1 and 2 cm in 16 cases (44.4%). In 31 cases (86.2%), FB composition was inorganic; organic ones were found in 5 cases (13.8%). The most frequently removed FBs were coins (36% of cases); in three patients, injuries were caused by the ingestion of a battery. Oral cavity FBs were located in the hard palate in four cases (80.0%); all objects were 3D and had rigid consistency and four objects (80.0%) were sharp. No FBs greater than 1 cm in maximum dimension were observed. In one case (20.0%), the FB was organic; in two cases (40.0%), it was a battery. FBs were removed during oropharyngoscopy (by means of forceps), operative oesophagoscopy or open oesophageal surgery; two cases of haematemesis due to sharp FBs were recorded: one of them was caused by oesophageal perforation. Patients who underwent oesophagoscopy in general anaesthesia were hospitalised. Analysing FB location and children age, a lower mean age is observed in tracheo-bronchial and oesophageal FBs, whereas auricular, nasal and pharyngeal localisations were recorded in older children (P < 0.05). Collecting and analysing data about FBs location and setting of the adverse event, we observed that among older children (age >3 years), there is a statistically significant correlation (P < 0.05) between site and setting: children commonly insert FBs in ears and nasal cavities while playing, conversely such objects frequently can be inhaled or dug into the pharynx or oesophagus while eating. Moreover, we observed a statistically significant correlation between age and pharyngeal FBs location: in older children (age >3 years), the most frequently removed FBs were fishbones because of the change in food composition. In younger children (age
