AERODIGESTIVE FOREIGN BODIES A public health concern Dr

AERODIGESTIVE FOREIGN BODIES: A public health concern Dr. Samson Kichiba MD Department of otorhinolaryngology. 27/4/2016

Introduction • Aero digestive fb means fbs in oesophagus and airway. • They remain to be common problem that contributes significantly to high morbidity and mortality worldwide and in our country specifically our setting.

epidemiology • Incidence has been constant over past several decades • Aspiration or ingestion • Common in extremes of ages • Common age group 1 -4 years. Ø <5 yrs – 84% of cases Ø <3 yrs – 73% of cases Ø M>F (2: 1)

• Children are naturally susceptible to fb because: Ø They lack molar teeth Ø The tendency to oral exploration Ø Tendency of playing during time of ingestion Ø Poor coordination of swallowing • On the other hand, elderly are those with Ø Thoracic neurological diseases Ø Decreased gag reflex due to alcohol seizures , stroke, parkinsonism, trauma and senile dementia.

Location of fb • Oesophageal fb commonly lodge; Ø Upper esophageal sphincter – Cricopharyngeus sphincter Ø Mid esophagus-level of aortic notch Ø Lower esophageal sphincter • Airway foreign bodies commonly lodge: Ø Larynx/glottis Ø Trachea Ø Bronchus, R>L

Etiology • Carelessness of parents • Explore environment • May not have full posterior dentition-needed for proper grinding of food • Less coordination of swallowing • Immaturity in laryngeal elevation and glottic closure • Running/playing at time of ingestion • May have anatomic or neurologic impairment • Poor vision, drug addiction, rapid eatig.

• Common fb in esophagus are; Ø Coins 75% Ø Disk batteries Ø Bones Ø Toys Ø Piece of metals

Disk batteries ØOne hour. Mucosa damage ØFour hours. Leakage of contents May cause erosion through muscular wall ØSix hoursperforation

• Common airway fb; Ø Groundnuts, pins, earrings, beans, dental prosthesis, pieces of charcol, stones, piece of bricks

Airway Foreign Bodies: Presentation Initial symptoms: coughing, choking, gagging Often an acute episode of gagging and choking. Symptoms: Laryngeal FB : stridor, hoarseness, croupy cough, sudden respiratory distess, aphonia, choking Ø Tracheobronchial FB: stridor, cough, SOB • About 50% of patients with foreign-body aspiration do not have a contributing history. • History of choking/coughing • • • Ø

• Oesophageal foreign bodies pts mainly present with h/o: Ø Dydphagia Ø Drooling of saliva Ø Odynophagia Ø Emesis

Diagnosis • challenge? ? ØLack of clear hx and characteristic clinical features ØAbsence of characteristic radiological findings Ø 20 -50% airway fb not detected initialy.

DX of airway fb • 5 -40% of patients with airway FB have no obvious signs. • Radiologic studies Ø PA/Lat CXR Ø PA/Lat neck films • Most airway foreign bodies are radiolucent (~80%). • Only patients with a stable airway should be taken for x-ray

Treatment of AFB • Heimlich maneuver • Respiratory support • Removal of object with laryngoscopy/bronchoscopy

DX of esophageal FB • Chest/Neck/Abdomen xray ØAP/Lateral ØLook for object ØSigns of perforation-subcutaneous emphysema, retroesophagealabscess, extraluminalportion of the foreign body Ø 25% of x rays are within normal limit.

Treatment of EFB • Removal of object with oesophagoscopy or Magillis forceps • Observation

Complications • • • Bleeding Accidental extubation Perforation Mediastinitis Aspiration

Challenges at BMC • ? ? ? ? ?

Thanks for listening.

Discussion