Airway foreign bodies in children are common diseases, including nasal and sinus foreign bodies; pharyngeal foreign bodies; laryngeal foreign bodies; tracheobronchial foreign bodies; esophageal foreign bodies, etc. Among them, foreign bodies like laryngeal foreign bodies and tracheal foreign bodies are acute diseases in children and need timely treatment; while nasal and sinus foreign bodies and esophageal foreign bodies can have more serious complications during and after surgical treatment, which also need to be paid great attention. The Department of Otolaryngology of Nanjing Children’s Hospital has handled a large number of airway foreign bodies since its establishment in 1978, including nearly 10,000 cases of tracheobronchial foreign bodies and more than 7,000 cases of esophageal foreign bodies, without a single death, and less than 5 per 1,000 critical complications, which is an unparalleled technical advantage in the province and even in China, while this statistic is extremely rare in any hospital. This is the result of the joint hard work of our new and old medical staff.
I. Nasal foreign body
It is a common foreign body disease in children, and most of them can be treated in outpatient clinic, while some patients need to be removed by nasal endoscopic surgery under anesthesia. Clinical symptoms are.
1, nasal odor, foul smell: is the most common symptom of nasal foreign body in children, parents often find that their children’s noses stink and do not subside after a long time, so once the nasal cavity has a long-term odor, there should be a high degree of suspicion that there is a foreign body in the nasal cavity.
2, anterior nasal bleeding Nasal bleeding is a common symptom in ENT, more than 80% is anterior nasal bleeding, anterior nasal bleeding is easier to handle. Almost all nasal bleeding in children occurs in the anterior part of the nasal cavity; anterior nasal bleeding in young people is common, and a few serious bleeding occurs in the posterior part of the nasal cavity.
3, nasal congestion Nasal congestion is a common symptom of the respiratory system, manifested as poor breathing and a feeling of foreign body blockage in the nasal cavity.
Usually, the severity of nasal foreign body is related to the nature of foreign body. Soft objects such as paper and wool often do not fall down, so they bring less harm, while soybean and metal foreign bodies sometimes fall down into the trachea and cause serious consequences; it is worth noting that, like button battery, even after the foreign body is removed, due to the corrosion of chemical liquid, about 90% of nasal septum perforation will occur clinically, which brings great difficulties to the later treatment The treatment includes
The treatment mainly includes anterior rhinoscopic foreign body removal, deep nasal endoscopic foreign body removal after anesthesia, and posterior nasal foreign body removal under X-ray, etc.
Second, pharyngeal and laryngeal foreign bodies
Most of them are sharp foreign bodies such as fish spikes and duck bones. Foreign bodies in the vocal fold area are usually combined with laryngeal edema and cause obstruction and asphyxia, which must be treated in time.
The main symptom of foreign body in the pharynx is sore throat, which is aggravated when swallowing, including continuous drooling, a symptom unique to children with foreign body in the pharynx. There is appetite but refusal to eat and violent crying when eating.
The main symptom of a foreign body in the larynx is dyspnea, often with hoarseness with inspiratory laryngeal tinnitus, and in severe cases, severe symptoms of cyanosis, coma, and asphyxia.
Treatment should be emergency treatment, timely surgical removal to relieve critical symptoms.
Tracheal and bronchial foreign body
Tracheal and bronchial foreign body is an acute disease, which is life-threatening if not treated in time. Statistics show that about 80%-90% of them occur in children under 5 years old, which is related to the poor swallowing function and imperfect development of epiglottis in children under 5 years old. The clinical manifestations of tracheobronchial foreign bodies in children are divided into 4 phases: foreign body aspiration phase: when the foreign body first enters the trachea, violent coughing, vomiting, shortness of breath and other symptoms may occur, and even life-threatening conditions such as hypoxia and asphyxia may occur. Quiet phase: When the foreign body is stabilized at a certain location in the tracheobronchus, there are no symptoms other than coughing. Inflammatory irritation period: As the foreign body stays longer, inflammation causes various symptoms in the lungs. Complication phase: Pulmonary atelectasis, emphysema, pulmonary solids, lung abscess, mediastinal emphysema or abscess can occur in this phase.
The severity of tracheal and bronchial foreign bodies is closely related to the nature, size, residence time, and degree of obstruction of the foreign body. Generally speaking, plant-based foreign bodies, such as peanut rice, are rich in fatty acids, irritating, and cause severe symptoms. Large foreign bodies can cause complete obstruction of the trachea, and the longer the foreign body stays, the more complete the obstruction and the more severe the clinical manifestations.
Tracheobronchial foreign body is a preventable disease, do not eat nutty foods under 15 years old, do not eat jelly and other snacks that can cause accidental aspiration. 2. Do not eat or hold food or foreign bodies while playing, eating, or joking. 3. Avoid nasal foreign bodies falling into the tracheobronchial tubes. Once a foreign body occurs in the tracheobronchus, a rigid bronchoscopy should be performed in time to remove the foreign body.
4. Esophageal foreign body
Esophageal foreign body is also a common disease in children, usually foreign bodies are: various coins, nut nuclei, pins, even needles, staples and other special foreign bodies. The disease is caused by the entrance of foreign bodies and accidental swallowing. Therefore, children should be taught not to put inedible objects into their mouths.
Clinical manifestations of esophageal foreign body: 1. difficulty in swallowing with saliva outflow. 2. Respiratory symptoms: such as coughing. Restricted neck movement. 4. Hemorrhage: If the foreign body damages the blood vessels, it can cause bleeding, especially lethal bleeding from damage to the aorta. Treatment is based on the removal of foreign body by esophagoscopy. However, due to some special sharp foreign bodies, it is more difficult to remove and there are more postoperative complications, so prevention is still the top priority for this disease.