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

2. 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.

3. 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)

4. 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.

5. 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

6. 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.

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

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

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

11. 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

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

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

14. 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

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

16. 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.

17. Treatment of EFB
Removal of object with oesophagoscopy or Magillis forceps
Observation

18. Complications Bleeding Accidental extubation Perforation Mediastinitis
Aspiration

19. Challenges at BMC
?????????

20. Thanks for listening.

21. Discussion