Rigid Bronchoscopy in Airway Foreign Bodies: Value of the Clinical and Radiological Signs

Abstract

Introduction Foreign body in airway is a common emergency in ENT practice. As we know, Rigid Bronchoscopy is the method of choice for removing it, although at times it leads to specialists performing unnecessary bronchoscopy, exposing patients to hazards of general anesthesia.Objective The objective of my study is to calculate sensitivity, specificity, positive predictive value, odds ratio from the clinical and radiological signs, comparing with the gold standard, the rigid bronchoscope procedure.Method This is a prospective analytical study designed at University Teaching Hospital and conducted over a period of 18 months, from March 2011 to August 2012. Data collection was broadly classified into three different categories: (1) Symptomatology, such as presence or absence of choking, cyanosis, and difficulty in breathing; (2) Clinical signs, such as the presence or absence of air entry, crackles, and rhonchi 3. Chest X-ray findings were suggestive of a foreign body.Results There were a total of 40 rigid bronchoscopies performed under general anesthesia for the diagnosis and therapeutic reasons. Among 40 patients who underwent rigid bronchoscopy, 32 (80%) were found to have varieties of foreign bodies in their airway while 8 patients (20%) had negative bronchoscopy. The history of choking is the only clinical symptoms which came out to be statistically Significant (p = 0.043) with odds ratio of 5.Conclusion Rigid bronchoscopy is the gold standard technique for diagnosis and procedure of choice to remove FB from airway. Regardless, it still presents a small chance of negative result, especially when there is no history of aspiration.

Update in the extraction of airway foreign bodies in adults

“…The classical triad of cough, dyspnea, and cyanosis occurs in only a small percentage of patients (11). A nonasphyxiating FB may be asymptomatic, especially in elderly people.…”

“…Although the rigid bronchoscope is still considered as the safest instrument in most pediatric centers to FB removal (11), most of the studies included in this review, considered the flexible bronchoscope as the initial and preferred method of choice to treat the adult airway ( Table 1).…”

Foreign body aspiration – still a challenge in pediatrics?

“…Performing bronchoscopy under general anesthesia remains the best method of diagnosis and treatment. Examination of the tracheobronchial tree with a rigid bronchoscope should be performed in all cases of foreign body aspiration suspicion in children (14). The complications of bronchoscopy, although rare, may be severe: pneumothorax, hemorrhage, cardiopulmonary arrest (12).…”

Aspiraţia De Corp Străin La Copil – Încă O Provocare În Pediatrie?

“…Efectuarea bronhoscopiei sub anestezie generală rămâne cea mai bună metodă de diagnostic şi tratament. Examinarea arborelui traheobronşic cu ajutorul bronhoscopului rigid ar trebui efectuată în toate cazurile de suspiciune de aspiraţie de corp străin la vârstă pediatrică (14). Complicaţiile bronhoscopiei, deşi rare, pot fi severe: pneumotorax, hemoragie, stop cardiorespirator (12).…”