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. <5 yrs – 84% of cases <3 yrs – 73% of cases M>F (2:1)

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

Location of fb Oesophageal fb commonly lodge; Upper esophageal sphincter Cricopharyngeus sphincter Mid esophagus-level of aortic notch Lower esophageal sphincter Airway foreign bodies commonly lodge: Larynx/glottis Trachea 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; Coins 75% Disk batteries Bones Toys Piece of metals

Disk batteries One hour- Mucosa damage Four hours- Leakage of contents May cause erosion through muscular wall Six hours- perforation

Common airway fb; 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 Tracheobronchial FB: stridor, cough, SOB About 50% of patients with foreign-body aspiration do not have a contributing history. History of choking/coughing

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

Diagnosis challenge???? Lack of clear hx and characteristic clinical features Absence of characteristic radiological findings 20-50% airway fb not detected initialy.

DX of airway fb 5-40% of patients with airway FB have no obvious signs. Radiologic studies PA/Lat CXR 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 AP/Lateral Look for object Signs of perforation-subcutaneous emphysema, retroesophagealabscess, extraluminalportion of the foreign body 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