Application of cystourethroscopy during tracheobronchial foreign body removal in children

Abstract

ObjectiveThis study aimed to describe preliminary experiences associated with removal of tracheobronchial foreign bodies (TFBs) by cystourethroscopy (CU).MethodsWe performed a retrospective analysis of 127 paediatric cases of TFB removal by CU at our centre from January 2009 to August 2016. Data that were extracted from the medical records included age, sex, location and nature of the TFBs, operation time, and complications.ResultsAll TFBs were successfully removed by CU. The mean time of the procedure was 3.38 ± 2.86 minutes. A total of 102 (80.31%) patients had successful removal of TFBs by CU during the initial trial, 19 (14.96%) were successfully treated in the second trial, and six (4.72%) required a third trial. Otolaryngologists with 2, 5, and 7 years of professional CU training showed a mean TFB removal time of 3.38 ± 2.13, 3.40 ± 3.60, and 3.37 ± 2.86 minutes, respectively. In the operations, oxygen saturation fell below 90% at an average occurrence of 0.39 times, but no patients showed a decrease below 85%. Only one patient experienced laryngeal oedema after the procedure.ConclusionCU is a useful technique and minimizes complications and operational risks during removal of paediatric TFBs.

The characteristics of foreign bodies aspirated by children across different continents: A comparative review

“…Out of the 14,471 cases in this review article, only 2551 reported a positive history of FBA and its associated complications. The rate of this event was 100% in Denmark 46 and Italy, 47 whereas India 17,18 (57.9%) and China 6,7,20–26,34,36,37 (52.8%) had the lowest witness rates. As presented in Table 4, Asian patients reported a higher number of choking history, while Europeans had fewer witnesses of FBA.…”

“…After screening and reviewing the articles, 14,471 cases were evaluated with 2852 females (40%) and 4290 males (60%) being the majority. India, 17,18 Pakistan, 19 and China 7,20–26 had the highest male‐to‐female ratios, while Sweden 14 and Iran 8 had ratios closer to 1. We were unable to determine the precise number of pediatric males and females from 12 articles 6,27–37 .…”

“…Flexible bronchoscopy is highly recommended as a diagnostic tool, especially in patients with no witnesses, negative radiological assessments, acute wheezing, first asthma attack, and recurrent pneumonia 47 . The soft and small outer diameter of the flexible bronchoscope makes it easier to reach deeper bronchi 7,18 . Rodrigues et al 35 recommended using a flexible bronchoscope in all inorganic FBs, whereas rigid bronchoscopes were found to be unnecessary.…”

“…Different cultures and diets are yet another effective factors in the regional variation of aspirated FBs. For instance, watermelon seeds were the most frequently aspirated FBs in China and Iran, whereas peanut was more prevalent in western countries 7,8 …”

“…For instance, watermelon seeds were the most frequently aspirated FBs in China and Iran, whereas peanut was more prevalent in western countries. 7,8 To the best of our knowledge, there are few review articles pertaining to FBA in children, and the literature poorly covers it.…”