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Appendix 4
International Journal of Pediatric Otorhinolaryngology 76S (2012) S12–S19

Contents lists available at SciVerse ScienceDirect

International Journal of Pediatric Otorhinolaryngology

j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / i j p o r l

Foreign bodies in the airways: A meta-analysis of published papers

Francesca Foltran a, Simonetta Ballali b, Francesco Maria Passali c, Eugene Kern d, Bruno Morra e,

Giulio Cesare Passali f, Paola Berchialla g, Maria Lauriello h, Dario Gregori a,*

a Laboratory of Epidemiological Methods and Biostatistics, Department of Environmental Medicine and Public Health, University of Padova, Padova, Italy

b Prochild ONLUS, Trieste, Italy

c Ear, Nose, and Throat Clinic, University ‘‘Tor Vergata’’, Rome, Italy

d ENT Department Mayo Clinic Rochester, NY, USA

e ENT Department, San Giovanni Battista ‘‘Molinette’’ Hospital, Turin, Italy

f ENT Department, Catholic University ‘‘The Sacred Heart’’ of Rome, Italy

g Department of Public Health and Microbiology, University of Torino, Italy

h Department of Experimental Medicine, University of L’Aquila, Italy

A R T I C L E I N F O
A B S T R A C T

Article history:
Background: Very recently, some attempts have been made to start a systematic collection of foreign

Available online 12 February 2012

bodies (FB) in view of using them to characterize the risk of chocking in terms of size, shape and

consistency of the FB. However, most of the epidemiologic evidence on foreign bodies in children comes

Keywords:
from single-center retrospective studies, without any systematic geographical and temporal coverage.

Airways
This paper is aimed at providing an estimate of the distribution of foreign body’s injuries in children

Foreign body

according to gender, age, type of FB, site of obstruction, clinical presentation, diagnostic/therapeutic

Meta-analysis
procedures, complications, as emerging from a meta-analytic review of published papers.

Methods: A free text search on PubMed database ((foreign bodies) OR (foreign body)) AND ((aspiration)

OR (airways) OR (tracheobronchial) OR (nasal) OR (inhalation) OR (obstruction) OR (choking) OR

(inhaled) OR (aspirations) OR (nose) OR (throat) OR (asphyxiation)) AND ((children) OR (child)) ﬁnalized

to identify all English written articles referring to foreign body inhalation over a 30 years period (1978–

2008) was performed. The target of the analysis has been deﬁned as the proportion of injuries as reported

in the studies, stratiﬁed according to children demographic characteristics, type of FB, site of obstruction.

The pooled proportions of FB were calculated using the DerSimonian and Laird approach.

Results: 1699 papers were retrieved and 1063 were judged pertinent; 214 English written case series

were identiﬁed, among them 174 articles were available and have been included in the analysis. Airway

foreign body most commonly occurs in young children, almost 20% of children who have inhaled foreign

bodies being between 0 and 3 years of age. Organic FB, particularly nuts, are the most documented
under the Official Information Act 1982

objects while, among inorganic FBs, the greatest pooled proportion has been recorded for magnets,

which can be particularly destructive in each location. Non speciﬁc symptoms or a complete absence of

symptoms are not unusual, justifying mistaken or delayed diagnosis. Acute and chronic complications

seem to occur in almost 15% of patients.

Conclusions: Even if an enormous heterogeneity among primary studies seems to exist and even if the

absence of variables standardized deﬁnitions across case series, including class age deﬁnition and

symptoms and signs descriptions, seriously impairs studies comparability, our results testify the

relevant morbidity associated with foreign body inhalation in children, stressing the importance of
Released

preventive measures.

ß 2012 Elsevier Ireland Ltd. All rights reserved.

1. Introduction
The inhalation/aspiration of foreign bodies (FB) into the upper

airways can be a very serious event, sometimes resulting in fatal

outcomes, and frequently having considerable social and economic

consequences. Therefore, in scientiﬁc literature great attention has

* Corresponding author at: Laboratory of Epidemiological Methods and

been devoted to this issue and several papers reporting single case

Biostatistics, Department of Environmental Medicine and Public Health, University

description or detailing features of a case series have been

of Padova, 35121 Padova, Italy. Tel.: +39 049 8215384; fax: +39 02 700445089.

E-mail address: [email address] (D. Gregori).

published. Also several narrative reviews discussed more clinical

0165-5876/$ – see front matter ß 2012 Elsevier Ireland Ltd. All rights reserved.

doi:10.1016/j.ijporl.2012.02.004

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F. Foltran et al. / International Journal of Pediatric Otorhinolaryngology 76S (2012) S12–S19
S13

aspects of the FB injuries, like clinical diagnosis and management
and FB characteristics. For each stratum, the number of articles

of the injured child [1]. Very recently, some attempts have been
reporting data about the considered characteristic, the number of

made to start a systematic collection of FB in view of using them to
cases having the considered characteristic and the total number of

characterize the risk of chocking in terms of size, shape and
cases described in the articles are reported. Particularly, in Table 2

consistency of the FB [2]. However, most of the epidemiologic
injuries pooled proportions are presented stratiﬁed by children age

evidence on foreign bodies in children comes from single-center
and sex, and by injury dynamics (including adult presence and

retrospective studies, without any systematic geographical and
activity before accident); moreover, details regarding FB locations

temporal coverage [3–7].
and FB types are presented respectively in Tables 3 and 4. In Table 5

Particularly, in spite of the wide interest proven by the high
pooled proportions of symptoms and signs are shown while in

number of published papers on the argument, no attempts have
Table 6 radiographic ﬁndings and adopted removal techniques are

been made to synthesize the epidemiological data as arising from
described. Finally, in Table 7 pooled proportions of diagnostic

the literature. This paper is an attempt aimed at ﬁlling this gap,
delay, mistaken diagnosis, complication and deaths are reported.

providing an estimate of the distribution of foreign body’s injuries

in children according to gender, age, type of FB, site of obstruction,
4. Discussion

clinical presentation, diagnostic/therapeutic procedures, compli-

cations, as emerging from a meta-analytic review of published
Taking stock of what is known in any ﬁeld involves reviewing

papers.
the existing literature, summarizing it in appropriate ways, and

exploring the implications of heterogeneity of population and

2. Materials and methods
study for heterogeneity of study results. Meta-analysis provides a

systematic way of performing this research synthesis, while

A free text search on PubMed database ((foreign bodies) OR
indicating when more research is necessary. Usually, meta-

(foreign body)) AND ((aspiration) OR (airways) OR (tracheobron-
analytic studies resume randomized controlled trials results,

chial) OR (nasal) OR (inhalation) OR (obstruction) OR (choking) OR
which are considered to provide the strongest evidence regarding

(inhaled) OR (aspirations) OR (nose) OR (throat) OR (asphyxiation))
an intervention. However, in many situations, including studies of

AND ((children) OR (child)) ﬁnalized to identify all articles
risk factors, only data from observational studies are available and,

referring to foreign body inhalation over a 30 yrs period (1978–
even if the extreme diversity of study designs and populations in

2008) was performed.
epidemiology could make the interpretation of simple summaries

Papers’ pertinence was independently evaluated by two
problematic, meta-analyses of observational studies continue to be

reviewers starting from title and abstract. Papers referring to
one of the few methods for answering urgent questions in clinical

adult FB injuries, other sites of injury other than aerial tract and
and public health research.

iatrogenic causes were excluded. Only case series were included in
Particularly, despite aspiration and inhalation of FBs are

the analysis while case reports were excluded. Papers referring to
common events in paediatrics accounting for a not negligible

the same series of data were included only once in the meta-
proportion of accidental deaths in children under 4 years of age,

analysis. Only case series written in English were included.
this issue is still poorly understood and existing knowledge not yet

For each record included in the analysis, information was
systematically reviewed and synthesized.

extracted on country, period, children sex and age, FB type, site of
Our study, in which 1063 were judged pertinent and only 174

obstruction, symptoms, signs, diagnostic and therapeutic proce-
English written case series were identiﬁed and included in the

dures, delay at the diagnosis, complications, number of deaths.
analysis, testiﬁes that the great amount of papers about this topic

The target of the analysis has been deﬁned as the proportion of
are case reports typically consisting of complaints, examination

injuries as reported in the studies, stratiﬁed according to children
ﬁndings, diagnosis, treatment and outcome; however, no hypoth-

demographic characteristics, injury dynamics, type of FB, site of
esis, data analysis or generalizable conclusion is possible on this

obstruction. Moreover, also symptoms, signs, radiological ﬁndings,
base. On the other hand, the absence of variables standardized

removal techniques, delayed or mistaken diagnosis, complications
deﬁnitions across case series, including class age deﬁnition and

under the Official Information Act 1982
and death have been considered and pooled proportion computed.
symptoms and signs descriptions, seriously impairs studies

The pooled proportions of FB was calculated using the
comparability. Moreover an enormous heterogeneity among

DerSimonian and Laird approach [8,9]. All studies with missing
primary studies seems to exist. Despite these limitations, results

values or zero counts were excluded pair wise from the analysis.
obtained in the present study stress some key messages.

First, a x2 test for homogeneity of proportions among the different
First of all, airway foreign body most commonly occurs in young

studies was performed using the Cochran method 43. Thus, the
children, almost 20% of children who have inhaled foreign bodies

pooled proportions of FB was estimated along with the corre-
being between 0 and 3 years of age. Great attention is paid in

Released
sponding 95% conﬁdence intervals (CI), using again the DerSimo-
scientiﬁc literature on objects causing the injury: organic FB,

nian-Laird random effects weighting scheme for the studies
particularly nuts, are the most documented objects while, among

included in the analysis.
inorganic FBs, the greatest pooled proportion has been recorded for

All analyses have been performed using the software R 44 [10]
magnets, which can be particularly destructive in each location.

with the rmeta package [11].
Moreover, injuries are frequently due to an incorrect manipulation

of objects not conceived for children use, including pins, nails,

3. Results
screws, ﬂoats.

The clinical presentation of foreign body aspiration ranges from

According with the search strategy previously described, 1699
none to severe airway obstruction; cough, chocking, dyspnea,

papers were retrieved and 1063 were judged pertinent; 214
reduced/abnormal breath sounds and respiratory movements

English written case series were identiﬁed, among them 174
decreased appear as the most documented symptoms and signs;

articles were available and have been included in the analysis.
however, non speciﬁc symptoms or a complete absence of

Considered references are shown in Table 1. On the whole, articles’
symptoms are not unusual, therefore, clinicians may fail to

authors observed 30,477 children suspected of having aspirated a
consider the diagnosis of an inhaled foreign body if child shows

foreign body. Pooled estimates of injury proportion are presented
no symptoms at presentation, especially when also chest radio-

in Tables 2–7 stratiﬁed for relevant variables including children
graph ﬁndings are normal. Even if chest radiograph ﬁndings

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S14
F. Foltran et al. / International Journal of Pediatric Otorhinolaryngology 76S (2012) S12–S19

Table 1

References considered in the meta-analysis.

Abdel-Rahman HA, 2000 [12]
Cohen SR, 1980 [13]
Keith FM, 1980 [14]
Reilly JS, 1992 [15]

Adaletli I, 2007 [16]
Das SK, 1984 [17]
Kohli GS, 1989 [18]
Righini CA, 2007 [19]

Adeyemo AO, 1986 [20]
Davies H, 1990 [21]
Lakhani JK, 1998 [22]
Roh JL, 2008 [23]

Agarwal RK, 1988 [24]
Divisi D, 2007 [25]
Lakhkar BB, 2000 [26]
Rothmann BF, 1980 [27]

Ahmed AA, 1994 [28]
Emir H, 2001 [29]
Laks Y, 1988 [30]
Rouillon I, 2006 [31]

Al-Ali MA, 2007 [32]
Endican S, 2006 [33]
Latiﬁ X, 2006 [34]
Samad L, 1998 [35]

al-Hilou R, 1991 [6]
Eren S, 2003 [36]
Lifschultz BD, 1996 [37]
Saquib Mallick M, 2005 [38]

Alleemudder D, 2007 [39]
Erikc¸i V, 2003 [40]
Lima JA, 1989 [41]
Schmidt, H., 2000 [42]

Altkorn R, 2008 [43]
Esclamado RM, 1987 [44]
Linegar AG, 1992 [45]
Sehgal A, 2002 [46]

Altmann A, 1995 [47]
Even L, 2005 [48]
Loh WS, 2003 [49]
Sersar SI, 2006 [50]

Altmann AE, 1997 [51]
Fadl FA, 1997 [52]
Ludemann JP, 2007 [53]
Shah MB, 2008 [54]

Ammari FF, 2000 [55]
Fraga A, 2008 [56]
Mahafza T, 2007 [57]
Shaikholeslami V, 1978 [58]

Andazola JJ, 1999 [59]
Franc¸ois M, 1998 [60]
Maitra AK, 1980 [61]
Shanmugham MS, 1984 [62]

Anyanwu CH, 1985 [63]
Gaafar H, 1982 [64]
Mantel K, 1986 [65]
Sharma AK, 1992 [66]

Arjmand EM, 1997 [67]
Gatch G, 1987 [68]
Martinot A, 1997 [69]
Shivakumar AM, 2003 [70]

Asif M, 2007 [71]
Gedlu E, 1994 [72]
McCormick S, 2002 [73]
Siddiqui MA, 2000 [74]

Assefa D, 2007 [75]
Girardi G, 2004 [76]
Melaku G, 1996 [77]
Sirmali M, 2005 [78]

Aydogan LB, 2006 [79]
Glynn F, 2008 [80]
Mene´ndez AA, 1991 [81]
Sisenda TM, 2002 [82]

Ayed AK, 2003 [83]
Goren S, 2005 [84]
Metrangelo S, 1999 [85]
Skoulakis CE, 2000 [86]

Backlin SA, 1995 [87]
Gregori D, 2007 [88]
Midulla F, 2005 [89]
Soboczynski A, 1993 [90]

Baker MD, 1987 [91]
Gregori D, 2008 [92]
Mittleman RE, 1984 [93]
Somanath BP, 1995 [94]

Balbani AP, 1998 [95]
Gregori D, 2008 [96]
Moazam F, 1983 [97]
Soysal O, 2006 [98]

Banerjee A, 1988 [99]
Gulati SP, 2003 [100]
Monden Y, 1989 [101]
Steen KH, 1990 [102]

Barbato A, 1996 [103]
Haliloglu M, 2003 [104]
Morley RE, 2004 [105]
Stoychev S, 1980 [106]

Barrios Fontoba JE, 1997 [107]
Hamdan AL, 2000 [108]
Mu L, 1991 [109]
Swanson KL, 2002 [110]

Beg MH, 1987 [111]
Hamilton AH, 1989 [112]
Mu LC, 1990 [113]
Tan HK, 2000 [114]

Ben Amer JH, 2000 [115]
Hasdiraz L, 2006 [116]
Nandapalan V, 1994 [117]
Tander B, 2004 [118]

Bhatia PL, 1991 [119]
Heyer CM, 2006 [120]
Ngo A, 2005 [121]
Tariq P, 1999 [122]

Bittencourt PF, 2006 [123]
Higo R, 2003 [124]
Oguz F, 2000 [125]
Tiago RS, 2006 [126]

Black RE, 1994 [127]
Hoeve LJ, 1993 [128]
Oguzkaya F, 1998 [129]
Tokar B, 2004 [130]

Blazer S, 1980 [131]
Hon SK, 2001 [132]
Ogunleye AO, 2001 [3]
Tomaske M, 2006 [133]

Bloom DC, 2005 [134]
Hong SJ, 2008 [135]
Ogunleye AO, 2004 [136]
Tong MC, 1996 [137]

Bodart E, 1999 [138]
Huang HJ, 2008 [139]
Ojwang J, 1985 [140]
Ulku¨ R, 2005 [141]

Botma M, 2000 [142]
Hussain S, 1988 [143]
Ortega M, 1986 [144]
Van Looij MA, 2003 [145]

Brkic F, 2007 [146]
Ibrahim Sersar S, 2005 [147]
Ozkurt H, 2008 [148]
Versichelen L, 1985 [149]

Burton EM, 1996 [150]
Ikeda M, 2001 [151]
Pasaoglu I, 1991 [152]
Wiseman NE, 1984 [153]

Caglayan S, 1989 [154]
Janik JS, 1986 [155]
Papsin BC, 1994 [156]
Wolach B, 1994 [157]

Cataneo AJ, 1997 [158]
Kadish HA, 1997 [159]
Peridis S, 2009 [160]
Wood RE, 1984 [161]

Cataneo AJ, 2008 [162]
Kadmon G, 2008 [163]
Pinto A, 2006 [164]
Yadav SP, 2007 [165]

Cevizci N, 2008 [166]
Kamath P, 2006 [167]
Pinzoni F, 2007 [168]
Yagi HI, 1997 [169]

Chiu CY, 2005 [170]
Karakoc¸ F, 2002 [171]
Poole SR, 1990 [172]
Zaytoun GM, 2000 [173]

Chung MK, 2007 [174]
Karakoc F, 2007 [175]
Puhakka H, 1989 [176]
Zerella JT, 1998 [177]

Ciftci AO, 2003 [178]
Karatzanis AD, 2007 [179]
Puterman M, 1982 [180]

Cleatus S, 1992 [181]
Kavanagh KT, 1986 [182]
Ramı´rez-Figueroa JL, 2005 [183]

Table 2

Injuries pooled proportions are presented stratiﬁed by demographic characteristics and injury dynamics. CI-lb: lower conﬁdence interval bounds. CI-ub: upper conﬁdence

interval bounds. P values less than 0.05 indicate signiﬁcant heterogeneity.
under the Official Information Act 1982

Number of articles
Cases
Total number of cases (N)
Pooled-proportion
CI-lb
CI-ub
p-Value

Demographic characteristics

Males
123
13,196
23,808
0.609
0.577
0.641
<0.001

Females
126
10,692
25,792
0.383
0.370
0.395
<0.001

Age 0–3
22
3240
4593
0.673
0.648
0.698
<0.001

Age > 3
30
2694
9495
0.254
0.216
0.292
<0.001

Injury dynamics

Released
Adult present
5
542
1044
0.563
0.279
0.846
<0.001

Child activity when injury occurred: playing
2
19
45
0.304
0.116
0.492
1.000

Child activity when injury occurred: eating
2
19
45
0.422
0.099
0.745
0.018

Table 3

Injuries pooled proportions are presented stratiﬁed by FB locations. CI-lb: lower conﬁdence interval bounds. CI-ub: upper conﬁdence interval bounds.

Number of articles
Cases
Total number (N)
Pooled-proportion
CI-lb
CI-ub

Nose
21
1475
1918
0.835
0.810
0.859

Larynx
49
559
6872
0.213
0.197
0.228

Trachea
97
2458
16,923
0.157
0.147
0.168

Bronchus
113
18,366
21,164
0.882
0.871
0.893

Lung
14
407
3960
0.271
0.252
0.289

Right side
99
9788
0
0.629
0.613
0.646

Left side
96
7582
0
0.425
0.408
0.441

Appendix 4
F. Foltran et al. / International Journal of Pediatric Otorhinolaryngology 76S (2012) S12–S19
S15

Table 4

Injuries pooled proportions are presented stratiﬁed by types of FB. CI-lb: lower conﬁdence interval bounds. CI-ub: upper conﬁdence interval bounds.

Number of Articles
Cases
Total number (N)
Pooled-proportion
CI-lb
CI-ub

Organic FB

Nuts
96
6504
18,536
0.395
0.340
0.450

Organic unspeciﬁed
55
5553
13,857
0.338
0.262
0.413

Seeds
64
3678
14,227
0.256
0.210
0.301

Unspeciﬁed food
24
421
3871
0.211
0.167
0.254

Weed/Wood
14
124
2633
0.136
0.093
0.180

Legumes
42
1406
11,058
0.107
0.084
0.131

Other food
21
266
2967
0.096
0.069
0.123

Grape
2
2
21
0.091
0.032
0.213

Maize
14
119
2216
0.050
0.030
0.070

Bones
35
393
7417
0.049
0.037
0.060

Meat
10
112
1870
0.040
0.019
0.061

Coffee grain
5
58
1210
0.034
0.005
0.063

Carrots
14
153
4284
0.034
0.021
0.047

Popcorn
16
122
2926
0.032
0.018
0.046

Chicken
3
50
1580
0.024
0.008
0.040

Candy
6
59
2713
0.021
0.007
0.036

Apples
12
88
3920
0.020
0.013
0.027

Hotdog
6
72
2710
0.019
0.001
0.039

Organic overall
172
19,113
29,881
0.558
0.549
0.567

Inorganic FB

Magnet
3
13
90
0.341
0.173
0.854

Sponge
5
42
264
0.146
0.044
0.249

Inorganic unspeciﬁed
69
2386
14,529
0.131
0.122
0.140

Other inorganic
36
751
6698
0.117
0.100
0.134

Foam
8
99
931
0.092
0.042
0.142

Battery
9
35
692
0.090
0.041
0.140

Toys
24
198
3031
0.081
0.059
0.103

Pen top
27
169
3569
0.080
0.051
0.110

Plastic pieces
54
629
8352
0.078
0.065
0.092

Pin nail tack screw
64
781
11,369
0.076
0.064
0.087

Paper
16
92
1498
0.061
0.038
0.083

Whistle
6
31
509
0.057
0.018
0.097

Button bead
19
264
3708
0.054
0.033
0.075

Coin
6
69
1560
0.050
0.021
0.080

Balls/balloon
21
87
2306
0.044
0.027
0.061

Cotton
4
18
497
0.029
0.008
0.051

Stones/shell
41
158
5210
0.027
0.020
0.035

Jewellery
12
31
1798
0.017
0.006
0.028

Pen/pencil
14
41
2933
0.011
0.006
0.015

Inorganic overall
172
5808
29,881
0.197
0.188
0.205

Table 5

Pooled proportions of symptoms and signs. CI-lb: lower conﬁdence interval bounds. CI-ub: upper conﬁdence interval bounds.

Number of articles
Cases
Total number (N)
Pooled-proportion
CI-lb
CI-ub

under the Official Information Act 1982
Symptoms
Cough
82
12,605
16,782
0.612
0.601
0.623

Choking
45
5947
11,680
0.468
0.353
0.583

Dyspnea
47
4507
9021
0.346
0.258
0.433

Throat pain
3
111
256
0.290
-0.035
0.614

Fever
53
1970
12,018
0.187
0.163
0.211

Toracic pain
9
43
661
0.140
0.121
0.160

Aspeciﬁc symptoms
11
147
1178
0.098
0.061
0.135

No symptoms
11
109
1327
0.079
0.046
0.111
Released

Vomiting
11
96
1013
0.074
0.047
0.100

Voice hoarsenes
10
73
1178
0.048
0.024
0.073

Blood stained mucus
10
59
1875
0.021
0.010
0.031

Unconsciouness
3
15
1625
0.008
0.000
0.016

Signs
Respiratory movements decreased
2
33
56
0.659
0.569
0.750

Decreased air entry
25
2672
4011
0.633
0.611
0.655

Decreased sounds
26
4262
8343
0.504
0.361
0.648

Abnormal breath sounds
78
5312
10,744
0.503
0.492
0.514

Tachypnea
15
2340
6723
0.476
0.451
0.501

Asimmetric auscultation
3
224
371
0.454
0.081
0.826

Acute Respiratory distress
10
986
3097
0.387
0.281
0.493

Nasal Flaring
5
94
395
0.340
0.189
0.491

Abnormal breath sounds wheezing
67
3152
7565
0.334
0.283
0.386

Nose pain
3
82
374
0.269
0.047
0.491

Abnormal breath sounds rhonchi
19
618
3271
0.204
0.151
0.257

Accessory muscles use
11
411
4193
0.196
0.147
0.244

Purulental discharge
8
232
1257
0.189
0.110
0.268

Appendix 4
S16
F. Foltran et al. / International Journal of Pediatric Otorhinolaryngology 76S (2012) S12–S19

Table 5 (Continued )

Number of articles
Cases
Total number (N)
Pooled-proportion
CI-lb
CI-ub

Abnormal breath sounds rales
9
412
2536
0.183
0.120
0.246

Abnormal breath sounds stridor
44
991
7147
0.177
0.149
0.205

Odor
4
52
312
0.150
0.056
0.243

Cyanosis
41
1258
9487
0.131
0.108
0.155

Abnormal breath sounds crackles
8
139
743
0.126
0.071
0.182

Nose bleeding
11
33
854
0.023
0.009
0.037

Subcutaneous emphysema
2
5
350
0.013
0.002
0.024

Table 6

Pooled proportions of radiographic ﬁndings and chosen removal techniques. CI-lb: lower conﬁdence interval bounds. CI-ub: upper conﬁdence interval bounds.

Number of Articles
Cases
Total Number (N)
Pooled-Proportion
CI-lb
CI-ub

Radiographic ﬁndings

Normal X-ray
75
5870
16,514
0.474
0.460
0.487

Rayradiopaque.FB
74
2525
16,155
0.246
0.234
0.259

Emphysema
76
5398
14,808
0.447
0.434
0.460

Atelectasis
63
2601
15,988
0.193
0.171
0.214

Pneumonia
59
1635
13,044
0.178
0.153
0.203

Pneumothorax/Pneumomediastinum
33
415
5425
0.078
0.064
0.093

Pleural effusion
7
166
2087
0.035
0.002
0.069

Number of performed X ray
98
18,236
18,446
0.990
0.984
0.995

Removal techniques

Bronchoscopy/laryngoscopy
111
19,125
19,677
0.990
0.984
0.995

Forceps
13
600
1220
0.474
0.460
0.487

Positive pressure technique
3
25
192
0.246
0.234
0.259

Surgery/thoracotomy/bronchotomy
47
479
15,153
0.447
0.434
0.460

Table 7

Pooled proportions of diagnostic delay, mistaken diagnosis, complication and deaths. CI-lb: lower conﬁdence interval bounds. CI-ub: upper conﬁdence interval.

Number of articles
Cases
Total number (N)
Pooled-proportion
CI-lb
CI-ub

Complications
Other infection
7
152
1443
0.162
0.031
0.293

Pneumonia Broncopneumonia
25
397
3605
0.106
0.084
0.127

Bronchiectasis
13
83
3742
0.096
0.053
0.140

Actelectasis
10
99
2601
0.028
0.014
0.042

Larynx edema
15
229
7874
0.025
0.016
0.033

Respiratory arrest
15
93
2886
0.024
0.013
0.035

Cardiopulmunary arrest
19
434
9683
0.020
0.011
0.030

Tracheal laceration
7
82
6156
0.006
0.001
0.013

Lung abscess empyema
6
14
1037
0.005
0.003
0.012

Pneumothorax/pneumomediastinum
23
56
7002
0.004
0.002
0.006

Pulmonary edema
6
8
476
0.003
0.000
0.007

Complications Overall
54
1482
13,684
0.157
0.131
0.184

Mistaken diagnosis

under the Official Information Act 1982
Asthma
5
54
1205
0.231
0.183
0.279

Infections
6
221
1273
0.307
0.257
0.356

Delay in diagnosis

Up to 24 h
49
3427
7625
0.470
0.452
0.488

Greater than 24 h
51
8027
11,118
0.601
0.585
0.617

Deaths
127
718
31,305
0.062
0.056
0.068

Released
compatible with an inhaled foreign body include air trapping,
patients after FB extraction and thus toward long terms

atelectasis, and pneumothorax, none of these ﬁndings are
outcomes.

pathognomonic for foreign body inhalation and in our study
Finally, only 5 article reported data regarding adult presence

almost half of cases had normal radiography, while deﬁnitive
during injury occurrence; this fact reveals the insufﬁcient attention

diagnosis is usually performed by endoscopic evaluation.
paid to preventive issues by both clinicians and parents while, on the

Diagnosis of an inhaled foreign body was delayed by more than
contrary, given the considerable mortality and morbidity associated

24 h in almost 40% of cases. As frequently reported in scientiﬁc
with foreign body inhalation in children, the importance of

literature, delayed diagnosis of an inhaled foreign body can result
preventive measures needs to be emphasized to parents and

in serious acute and chronic complications which seem to occur in
caregivers.

almost 15% of patients. Particularly, pneumonia and broncho-

pneumonia seem to be the most frequently documented in
References

analyzed case series.

Interestingly, while data regarding FB type are almost always
[1] V. Erikci, S. Karacay, A. Arikan, Foreign body aspiration: a four-years experience,

Ulus Travma Derg. 9 (January (1)) (2003) 45–49.
reported, only a relatively small proportion of articles presents

[2] B.K. Reilly, D. Stool, X. Chen, G. Rider, S.E. Stool, J.S. Reilly, Foreign body injury in

details regarding clinical presentation, diagnostic procedures and
children in the twentieth century: a modern comparison to the Jackson collec-

complications revealing poor attention toward the follow up of
tion, Int. J. Pediatr. Otorhinolaryngol. 67S1 (2003) S171–S174.

Appendix 4
F. Foltran et al. / International Journal of Pediatric Otorhinolaryngology 76S (2012) S12–S19
S17

[3] A.O. Ogunleye, O.G. Nwaorgu, O.A. Sogebi, Upper airway obstruction in Nigeria:
[36] S. Eren, A.E. Balci, B. Dikici, M. Doblan, M.N. Eren, Foreign body aspiration in

an aetiological proﬁle and review of the literature, Trop. Doct. 31 (October (4))
children: experience of 1160 cases, Ann. Trop. Paediatr. 23 (March (1)) (2003)

(2001) 195–197.
31–37.

[4] B.C. Becker, T.G. Nielsen, Foreign bodies in the airways and esophagus in
[37] B.D. Lifschultz, E.R. Donoghue, Deaths due to foreign body aspiration in children: the

children, Ugeskr. Laeger 156 (July (30)) (1994) 4336–4339.
continuing hazard of toy balloons, J. Forensic Sci. 41 (March (2)) (1996) 247–251.

[5] J. Lao, H.E. Bostwick, S. Berezin, M.S. Halata, L.J. Newman, M.S. Medow, Esoph-
[38] M. Saquib Mallick, A. Rauf Khan, A. Al-Bassam, Late presentation of tracheo-

ageal food impaction in children, Pediatr. Emerg. Care 19 (December (6)) (2003)
bronchial foreign body aspiration in children, J. Trop. Pediatr. 51 (June (3))

402–407.
(2005) 145–148.

[6] R. al-Hilou, Inhalation of foreign bodies by children: review of experience with
[39] D. Alleemudder, A. Sonsale, S. Ali, Positive pressure technique for removal of

74 cases from Dubai, J. Laryngol. Otol. 105 (June (6)) (1991) 466–470.
nasal foreign bodies, Int. J. Pediatr. Otorhinolaryngol. 71 (November (11)) (2007)

[7] T. Mahafza, A. Batieha, M. Suboh, T. Khrais, Esophageal foreign bodies: a
1809–1811.

Jordanian experience, Int. J. Pediatr. Otorhinolaryngol. 64 (July (3)) (2002)
[40] V. Erikci, S. Karacay, A. Arikan, Foreign body aspiration: a four-years experience,

225–227.
Ulus Travma Acil Cerrahi Derg. 9 (January (1)) (2003) 45–49.

[8] W. Cochran, The combination of estimates from different experiments, Bio-
[41] J.A. Lima, Laryngeal foreign bodies in children: a persistent, life-threatening

metrics 10 (1954) 101–129.
problem, Laryngoscope 99 (April (4)) (1989) 415–420.

[9] R. DerSimonian, L.N., Meta-analysis in clinical trials, Control. Clin. Trials 7 (1986)
[42] H. Schmidt, B.C. Manegold, Foreign body aspiration in children, Surg. Endosc. 14

177–188.
(July (7)) (2000) 644–648.

[10] T. Lumley, The RMETA Package, 2003.
[43] R. Altkorn, X. Chen, S. Milkovich, D. Stool, G. Rider, C.M. Bailey, et al., Fatal and

[11] Team RDC, R: A Language and Environment for Statistical Computing,
R
non-fatal food injuries among children (aged 0–14 years), Int. J. Pediatr. Otor-

Foundation for Statistical Computing, Vienna, Austria, 2003.
hinolaryngol. 72 (July (7)) (2008) 1041–1046.

[12] H.A. Abdel-Rahman, Fatal suffocation by rubber balloons in children: mecha-
[44] R.M. Esclamado, M.A. Richardson, Laryngotracheal foreign bodies in children. A

nism and prevention, Forensic Sci. Int. 108 (February (2)) (2000) 97–105.
comparison with bronchial foreign bodies, Am. J. Dis. Child. 141 (March (3))

[13] S.R. Cohen, W.I. Herbert, G.B. Lewis Jr., K.A. Geller, Foreign bodies in the airway.
(1987) 259–262.

Five-year retrospective study with special reference to management, Ann. Otol.
[45] A.G. Linegar, U.O. von Oppell, S. Hegemann, M. de Groot, J.A. Odell, Tracheo-

Rhinol. Laryngol. 89 (September–October (5 Pt 1)) (1980) 437–442.
bronchial foreign bodies. Experience at Red Cross Children’s Hospital, 1985–

[14] F.M. Keith, E.J. Charrette, R.B. Lynn, T.A. Salerno, Inhalation of foreign bodies by
1990, S. Afr. Med. J. 82 (September (3)) (1992) 164–167.

children: a continuing challege in management, Can. Med. Assoc. J. 122 (January
[46] A. Sehgal, V. Singh, J. Chandra, N.N. Mathur, Foreign body aspiration, Indian

(152)) (1980) 5–7.
Pediatr. 39 (November (11)) (2002) 1006–1010.

[15] J.S. Reilly, Airway foreign bodies: update and analysis, Int. Anesthesiol. Clin. 30
[47] A. Altmann, T. Nolan, Non-intentional asphyxiation deaths due to upper airway

(4) (1992 Fall) 49–55.
interference in children 0 to 14 years, Inj. Prev. 1 (June (2)) (1995) 76–80.

[16] I. Adaletli, S. Kurugoglu, S. Ulus, H. Ozer, M. Elicevik, F. Kantarci, et al., Utilization
[48] L. Even, N. Heno, Y. Talmon, E. Samet, Z. Zonis, A. Kugelman, Diagnostic evalua-

of low-dose multidetector CT and virtual bronchoscopy in children with sus-
tion of foreign body aspiration in children: a prospective study, J. Pediatr. Surg.

pected foreign body aspiration, Pediatr. Radiol. 37 (January (1)) (2007) 33–40.
40 (July (7)) (2005) 1122–1127.

[17] S.K. Das, Aetiological evaluation of foreign bodies in the ear and nose, J. Laryngol.
[49] W.S. Loh, J.L. Leong, H.K. Tan, Hazardous foreign bodies: complications and

Otol. 98 (October (10)) (1984) 989–991.
management of button batteries in nose, Ann. Otol. Rhinol. Laryngol. 112 (April

[18] G.S. Kohli, S.P. Yadav, J.K. Sahni, H. Goel, L. Jain, Thorny foreign bodies of upper
(4)) (2003) 379–383.

airway, Indian J. Chest Dis. Allied Sci. 31 (April–June (2)) (1989) 105–108.
[50] S.I. Sersar, W.H. Rizk, M. Bilal, M.M. El Diasty, T.A. Eltantawy, B.B. Abdelhakam,

[19] C.A. Righini, N. Morel, A. Karkas, E. Reyt, K. Ferretti, I. Pin, et al., What is the
et al., Inhaled foreign bodies: presentation, management and value of history

diagnostic value of ﬂexible bronchoscopy in the initial investigation of children
and plain chest radiography in delayed presentation, Otolaryngol. Head Neck

with suspected foreign body aspiration? Int. J. Pediatr. Otorhinolaryngol. 71
Surg. 134 (January (1)) (2006) 92–99.

(September (9)) (2007) 1383–1390.
[51] A.E. Altmann, J. Ozanne-Smith, Non-fatal asphyxiation and foreign body inges-

[20] A.O. Adeyemo, M.A. Bankole, Foreign bodies in the tracheobronchial tree:
tion in children 0–14 years, Inj. Prev. 3 (September (3)) (1997) 176–182.

management and complications, J. Natl. Med. Assoc. 78 (June (6)) (1986)
[52] F.A. Fadl, M.I. Omer, Tracheobronchial foreign bodies: a review of children

511–516.
admitted for bronchoscopy at King Fahd Specialist Hospital, Al Gassim, Saudi

[21] H. Davies, I. Gordon, D.J. Matthew, P. Helms, I.J. Kenney, J.E. Lutkin, et al., Long
Arabia, Ann. Trop. Paediatr. 17 (December (4)) (1997) 309–313.

term follow up after inhalation of foreign bodies, Arch. Dis. Child. 65 (June (6))
[53] J.P. Ludemann, K.H. Riding, Choking on pins, needles and a blowdart: aspiration

(1990) 619–621.
of sharp, metallic foreign bodies secondary to careless behavior in seven

[22] J.K. Lakhani, Bronchial foreign bodies lateralisation in children, Indian Pediatr. 35
adolescents, Int. J. Pediatr. Otorhinolaryngol. 71 (February (2)) (2007) 307–310.

(August (8)) (1998) 798–799.
[54] M.B. Shah, J.P. Bent, A.G. Vicencio, H. Veler, R. Arens, S.R. Parikh, Flexible

[23] J.L. Roh, S.J. Hong, Lung recovery after rigid bronchoscopic removal of tracheo-
bronchoscopy and interdisciplinary collaboration in pediatric large airway

bronchial foreign bodies in children, Int. J. Pediatr. Otorhinolaryngol. 72 (May
disease, Int. J. Pediatr. Otorhinolaryngol. 72 (December (12)) (2008) 1771–1776.

(5)) (2008) 635–641.
[55] F.F. Ammari, K.T. Faris, T.M. Mahafza, Inhalation of wild barley into the airways:

[24] R.K. Agarwal, G. Banerjee, N. Shembish, B.A. Jamal, C. Kareemullah, A. Swaleh,
two different outcomes, Saudi Med. J. 21 (May (5)) (2000) 468–470.

Foreign bodies in the tracheobronchial tree: a review of 102 cases in Benghazi,
[56] M. Fraga Ade, M.C. Reis, M.P. Zambon, I.C. Toro, J.D. Ribeiro, E.C. Baracat, Foreign

Libya, Ann. Trop. Paediatr. 8 (December (4)) (1988) 213–216.
body aspiration in children: clinical aspects, radiological aspects and broncho-

[25] D. Divisi, S. Di Tommaso, M. Garramone, W. Di Francescantonio, R.M. Crisci, A.M.
scopic treatment, J. Bras. Pneumol. 34 (February (2)) (2008) 74–82.

Costa, et al., Foreign bodies aspirated in children: role of bronchoscopy, Thorac.
[57] T. Mahafza, Y. Khader, Aspirated tracheobronchial foreign bodies: a Jordanian
under the Official Information Act 1982

Cardiovasc. Surg. 55 (June (4)) (2007) 249–252.
experience, Ear. Nose. Throat J. 86 (February (2)) (2007) 107–110.

[26] B.B. Lakhkar, P. Kini, V. Shenoy, N. Bhaskaranand, Foreign body aspiration:
[58] V. Shaikholeslami, Anaesthesia in bronochoscopic removal of inhaled bodies.

Manipal experience, Indian Pediatr. 37 (February (2)) (2000) 193–195.
Report of 173 cases, Acta Med. Iran. 21 (1) (1978) 47–51.

[27] B.F. Rothmann, C.R. Boeckman, Foreign bodies in the larynx and tracheobron-
[59] J.J. Andazola, R.E. Sapien, The choking child: what happens before the ambulance

chial tree in children. A review of 225 cases, Ann. Otol. Rhinol. Laryngol. 89
arrives? Prehosp. Emerg. Care 3 (January–March (1)) (1999) 7–10.

(September–October (5 Pt 1)) (1980) 434–436.
[60] M. Francois, R. Hamrioui, P. Narcy, Nasal foreign bodies in children, Eur. Arch.

[28] A.A. Ahmed, Bronchoscopic extraction of aspirated foreign bodies in children in
Otorhinolaryngol. 255 (3) (1998) 132–134.

Harare Central Hospital, Harare, Zimbabwe, Cent. Afr. J. Med. 40 (July (7)) (1994)
[61] A.K. Maitra, Casualty experience of swallowed foreign body, Br. J. Clin. Pract. 34

183–186.
(January (115–117)) (1980) 24.

Released
[29] H. Emir, G. Tekant, C. Besik, M. Elicevik, O.F. Senyuz, C. Buyukunal, et al.,
[62] M.S. Shanmugham, The incidence of inhaled foreign body in West Malaysia,

Bronchoscopic removal of tracheobroncheal foreign bodies: value of patient
Singapore Med. J. 25 (February (1)) (1984) 52–53.

history and timing, Pediatr. Surg. Int. 17 (March (2–3)) (2001) 85–87.
[63] C.H. Anyanwu, Foreign body airway obstruction in Nigerian children, J. Trop.

[30] Y. Laks, Z. Barzilay, Foreign body aspiration in childhood, Pediatr. Emerg. Care 4
Pediatr. 31 (June (3)) (1985) 170–173.

(June (2)) (1988) 102–106.
[64] H. Gaafar, M. Abdel-Dayem, M. Talaat, M. Mandour, The value of X-ray exami-

[31] I. Rouillon, J.B. Charrier, D. Devictor, F. Portier, I.K. Lebret, P. Attal, et al., Lower
nation in the diagnosis of tracheobronchial foreign bodies in infants and chil-

respiratory tract foreign bodies: a retrospective review of morbidity, mortality
dren, ORL. J. Otorhinolaryngol. Relat. Spec. 44 (6) (1982) 340–348.

and ﬁrst aid management, Int. J. Pediatr. Otorhinolaryngol. 70 (November (11))
[65] K. Mantel, I. Butenandt, Tracheobronchial foreign body aspiration in childhood. A

(2006) 1949–1955.
report on 224 cases, Eur. J. Pediatr. 145 (August (3)) (1986) 211–216.

[32] M.A. Al-Ali, B. Khassawneh, F. Alzoubi, Utility of ﬁberoptic bronchoscopy for
[66] A.K. Sharma, L.D. Agarwal, G. Prabhakar, A. Gupta, C. Sharma, S. Chandra,

retrieval of aspirated headscarf pins, Respiration 74 (3) (2007) 309–313.
Therapeutic and diagnostic role of bronchoscopy in pediatric age group, Indian

[33] S. Endican, J.P. Garap, S.P. Dubey, Ear, nose and throat foreign bodies in Melane-
Pediatr. 29 (March (3)) (1992) 287–290.

sian children: an analysis of 1037 cases, Int. J. Pediatr. Otorhinolaryngol. 70
[67] E.M. Arjmand, H.R. Muntz, S.L. Stratmann, Insurance status as a risk factor for

(September (9)) (2006) 1539–1545.
foreign body ingestion or aspiration, Int. J. Pediatr. Otorhinolaryngol. 42 (October

[34] X. Latiﬁ, A. Mustafa, Q. Hysenaj, Rigid tracheobronchoscopy in the management
(1)) (1997) 25–29.

of airway foreign bodies: 10 years experience in Kosovo, Int. J. Pediatr. Otorhi-
[68] G. Gatch, L. Myre, R.E. Black, Foreign body aspiration in children. Causes,

nolaryngol. 70 (December (12)) (2006) 2055–2059.
diagnosis, and prevention, AORN J. 46 (November (5)) (1987) 850–861.

[35] L. Samad, M. Ali, H. Ramzi, Tracheobronchial foreign bodies in children: reaching
[69] A. Martinot, M. Closset, C.H. Marquette, V. Hue, A. Deschildre, P. Ramon, et al.,

a diagnosis, J. Pak. Med. Assoc. 48 (November (11)) (1998) 332–334.
Indications for ﬂexible versus rigid bronchoscopy in children with suspected

Appendix 4
S18
F. Foltran et al. / International Journal of Pediatric Otorhinolaryngology 76S (2012) S12–S19

foreign-body aspiration, Am. J. Respir. Crit. Care Med. 155 (May (5)) (1997)
[100] S.P. Gulati, A. Kumar, A. Sachdeva, S. Arora, Groundnut as the commonest foreign

1676–1679.
body of tracheobronchial tree in winter in Northern India. An analysis of

[70] A.M. Shivakumar, A.S. Naik, K.B. Prashanth, K.D. Shetty, D.S. Praveen, Tracheo-
fourteen cases, Indian J. Med. Sci. 57 (June (6)) (2003) 244–248.

bronchial foreign bodies, Indian J. Pediatr. 70 (October (10)) (2003) 793–797.
[101] Y. Monden, T. Morimoto, T. Taniki, T. Uyama, S. Kimura, Flexible bronchoscopy

[71] M. Asif, S.A. Shah, F. Khan, R. Ghani, Analysis of tracheobronchial foreign bodies
for foreign body in airway, Tokushima J. Exp. Med. 36 (June (1–2)) (1989) 35–39.

with respect to sex, age, type and presentation, J Ayub Med Coll Abbottabad. 19
[102] K.H. Steen, T. Zimmermann, Tracheobronchial aspiration of foreign bodies in

(January–March (1)) (2007) 13–15.
children: a study of 94 cases, Laryngoscope 100 (May (5)) (1990) 525–530.

[72] E. Gedlu, Accidental injuries among children in north-west Ethiopia, East Afr.
[103] A. Barbato, A. Novello Jr., F. Tormena, P. Corner, Problems with the retrieval of

Med. J. 71 (December (12)) (1994) 807–810.
long-standing inhaled foreign bodies in children, Monaldi Arch. Chest Dis. 51

[73] S. McCormick, P. Brennan, J. Yassa, R. Shawis, Children and mini-magnets: an
(October (5)) (1996) 419–420.

almost fatal attraction, Emerg. Med. J. 19 (January (1)) (2002) 71–73.
[104] M. Haliloglu, A.O. Ciftci, A. Oto, B. Gumus, F.C. Tanyel, M.E. Senocak, et al., CT

[74] M.A. Siddiqui, A.H. Banjar, S.M. Al-Najjar, M.M. Al-Fattani, M.F. Aly, Frequency of
virtual bronchoscopy in the evaluation of children with suspected foreign body

tracheobronchial foreign bodies in children and adolescents, Saudi Med. J. 21
aspiration, Eur. J. Radiol. 48 (November (2)) (2003) 188–192.

(April (4)) (2000) 368–371.
[105] R.E. Morley, J.P. Ludemann, J.P. Moxham, F.K. Kozak, K.H. Riding, Foreign body

[75] D. Assefa, N. Amin, G. Stringel, A.J. Dozor, Use of decubitus radiographs in the
aspiration in infants and toddlers: recent trends in British Columbia, J. Otolar-

diagnosis of foreign body aspiration in young children, Pediatr. Emerg. Care 23
yngol. 33 (February (1)) (2004) 37–41.

(March (3)) (2007) 154–157.
[106] S. Stoychev, A. Gjulev, Clinical study of foreign metal bodies in the airways, Folia

[76] G. Girardi, A.M. Contador, J.A. Castro-Rodriguez, Two new radiological ﬁndings to
Med. (Plovdiv) 22 (3) (1980) 19–21.

improve the diagnosis of bronchial foreign-body aspiration in children, Pediatr.
[107] J.E. Barrios Fontoba, C. Gutierrez, J. Lluna, J.J. Vila, J. Poquet, S. Ruiz-Company,

Pulmonol. 38 (September (3)) (2004) 261–264.
Bronchial foreign body: should bronchoscopy be performed in all patients with a

[77] G. Melaku, Foreign body aspiration in children: experience from Ethiopia, East
choking crisis? Pediatr. Surg. Int. 12 (February (2–3)) (1997) 118–120.

Afr. Med. J. 73 (July (7)) (1996) 459–462.
[108] A.L. Hamdan, S.M. Mroueh, F.F. Bitar, F.T. Farhat, Foreign body retrieval in

[78] M. Sirmali, H. Turut, E. Kisacik, G. Findik, S. Kaya, I. Tastepe, The relationship
children with respiratory symptoms and no history of aspiration, Middle East

between time of admittance and complications in paediatric tracheobronchial
J. Anesthesiol. 15 (October (6)) (2000) 673–680.

foreign body aspiration, Acta Chir. Belg. 105 (November–December (6)) (2005)
[109] L. Mu, P. He, D. Sun, Inhalation of foreign bodies in Chinese children: a review of

631–634.
400 cases, Laryngoscope 101 (June (6 Pt 1)) (1991) 657–660.

[79] L.B. Aydogan, U. Tuncer, L. Soylu, M. Kiroglu, C. Ozsahinoglu, Rigid bronchoscopy
[110] K.L. Swanson, U.B. Prakash, D.E. Midthun, E.S. Edell, J.P. Utz, J.C. McDougall, et al.,

for the suspicion of foreign body in the airway, Int. J. Pediatr. Otorhinolaryngol.
Flexible bronchoscopic management of airway foreign bodies in children, Chest

70 (May (5)) (2006) 823–828.
121 (May (5)) (2002) 1695–1700.

[80] F. Glynn, M. Amin, J. Kinsella, Nasal foreign bodies in children: should they have a
[111] M.H. Beg, Reyazuddin, A. Hasan, Inhaled foreign bodies, Indian Pediatr. 24 (July

plain radiograph in the accident and emergency? Pediatr. Emerg. Care 24 (April
(7)) (1987) 583–585.

(4)) (2008) 217–218.
[112] A.H. Hamilton, F. Carswell, J.D. Wisheart, The Bristol Children’s Hospital experi-

[81] A.A. Menendez, F. Gotay Cruz, F.J. Seda, W. Velez, J. Trinidad Pinedo, Foreign body
ence of tracheobronchial foreign bodies 1977–87, Bristol Med. Chir. J. 104

aspiration: experience at the University Pediatric Hospital, P. R. Health Sci. J. 10
(August (3)) (1989) 72–74.

(December (3)) (1991) 127–133.
[113] L.C. Mu, D.Q. Sun, P. He, Radiological diagnosis of aspirated foreign bodies in

[82] T.M. Sisenda, B.O. Khwa-Otsyula, J.O. Wambani, Management of tracheo-bron-
children: review of 343 cases, J. Laryngol. Otol. 104 (October (10)) (1990)

chial foreign bodies in children, East Afr. Med. J. 79 (November (11)) (2002)
778–782.

580–583.
[114] H.K. Tan, K. Brown, T. McGill, M.A. Kenna, D.P. Lund, G.B. Healy, Airway foreign

[83] A.K. Ayed, A.M. Jafar, A. Owayed, Foreign body aspiration in children: diagnosis
bodies (FB): a 10-year review, Int. J. Pediatr. Otorhinolaryngol. 56 (December (2))

and treatment, Pediatr. Surg. Int. 19 (August (6)) (2003) 485–488.
(2000) 91–99.

[84] S. Goren, F. Gurkan, Y. Tirasci, Z. Kaya, K. Acar, Foreign body asphyxiation in
[115] J.H. Ben Amer, C. Kareemullah, M.H. Ben Amer, A. Shembish, Tracheobronchial

children, Indian Pediatr. 42 (November (11)) (2005) 1131–1133.
foreign bodies in children, Saudi Med. J. 21 (July (7)) (2000) 672–674.

[85] S. Metrangelo, C. Monetti, L. Meneghini, N. Zadra, F. Giusti, Eight years’ experi-
[116] L. Hasdiraz, F. Oguzkaya, M. Bilgin, C. Bicer, Complications of bronchoscopy for

ence with foreign-body aspiration in children: what is really important for a
foreign body removal: experience in 1,035 cases, Ann. Saudi Med. 26 (July–

timely diagnosis? J. Pediatr. Surg. 34 (August (8)) (1999) 1229–1231.
August (4)) (2006) 283–287.

[86] C.E. Skoulakis, P.G. Doxas, C.E. Papadakis, E. Proimos, P. Christodoulou, J.G.
[117] V. Nandapalan, J.C. McIlwain, Removal of nasal foreign bodies with a Fogarty

Bizakis, et al., Bronchoscopy for foreign body removal in children. A review
biliary balloon catheter, J. Laryngol. Otol. 108 (September (9)) (1994) 758–760.

and analysis of 210 cases, Int. J. Pediatr. Otorhinolaryngol. 53 (June (2)) (2000)
[118] B. Tander, B. Kirdar, E. Ariturk, R. Rizalar, F. Bernay, Why nut? The aspiration of

143–148.
hazelnuts has become a public health problem among small children in the

[87] S.A. Backlin, Positive-pressure technique for nasal foreign body removal in
central and eastern Black Sea regions of Turkey, Pediatr. Surg. Int. 20 (July (7))

children, Ann. Emerg. Med. 25 (April (4)) (1995) 554–555.
(2004) 502–504.

[88] D. Gregori, B. Morra, S. Snidero, C. Scarinzi, G.C. Passali, A. Rinaldi Ceroni, et al.,
[119] P.L. Bhatia, Problems in the management of aspirated foreign bodies, West Afr. J.

Foreign bodies in the upper airways: the experience of two Italian hospitals, J.
Med. 10 (April–June (2)) (1991) 158–167.

Prev. Med. Hyg. 48 (March (1)) (2007) 24–26.
[120] C.M. Heyer, M.E. Bollmeier, L. Rossler, T.G. Nuesslein, V. Stephan, T.T. Bauer, et al.,

[89] F. Midulla, R. Guidi, A. Barbato, P. Capocaccia, N. Forenza, G. Marseglia, et al.,
Evaluation of clinical, radiologic, and laboratory prebronchoscopy ﬁndings in

Foreign body aspiration in children, Pediatr Int. 47 (December (6)) (2005)
children with suspected foreign body aspiration, J. Pediatr. Surg. 41 (November

663–668.
(11)) (2006) 1882–1888.
under the Official Information Act 1982

[90] A. Soboczynski, A. Skuratowicz, M. Grzegorowski, I. Chwirot-Glyda, The problem
[121] A. Ngo, K.C. Ng, T.P. Sim, Otorhinolaryngeal foreign bodies in children presenting

of lower respiratory tract foreign bodies in children, Acta Otorhinolaryngol. Belg.
to the emergency department, Singapore Med. J. 46 (April (4)) (2005) 172–178.

47 (4) (1993) 443–447.
[122] P. Tariq, Foreign body aspiration in children—a persistent problem, J. Pak. Med.

[91] M.D. Baker, Foreign bodies of the ears and nose in childhood, Pediatr. Emerg.
Assoc. 49 (February (2)) (1999) 33–36.

Care 3 (June (2)) (1987) 67–70.
[123] P.F. Bittencourt, P.A. Camargos, P. Scheinmann, J. de Blic, Foreign body aspira-

[92] D. Gregori, L. Salerni, C. Scarinzi, B. Morra, P. Berchialla, S. Snidero, et al., Foreign
tion: clinical, radiological ﬁndings and factors associated with its late removal,

bodies in the upper airways causing complications and requiring hospitalization
Int. J. Pediatr. Otorhinolaryngol. 70 (May (5)) (2006) 879–884.

in children aged 0–14 years: results from the ESFBI study, Eur. Arch. Otorhino-
[124] R. Higo, Y. Matsumoto, K. Ichimura, K. Kaga, Foreign bodies in the aerodigestive

laryngol. 265 (August (8)) (2008) 971–978.
tract in pediatric patients, Auris, Nasus, Larynx 30 (December (4)) (2003)

Released
[93] R.E. Mittleman, Fatal choking in infants and children, Am. J. Forensic Med. Pathol.
397–401.

5 (September (3)) (1984) 201–210.
[125] F. Oguz, A. Citak, E. Unuvar, M. Sidal, Airway foreign bodies in childhood, Int. J.

[94] B.P. Somanath, S. Singhi, Airway foreign bodies in children, Indian Pediatr. 32
Pediatr. Otorhinolaryngol. 52 (January (1)) (2000) 11–16.

(August (8)) (1995) 890–897.
[126] R.S. Tiago, D.C. Salgado, J.P. Correa, M.R. Pio, E.E. Lambert, Foreign body in ear,

[95] A.P. Balbani, T.G. Sanchez, O. Butugan, M.A. Kii, F.V. Angelico Jr., C.M. Ikino, et al.,
nose and oropharynx: experience from a tertiary hospital, Braz. J. Otorhinolar-

Ear and nose foreign body removal in children, Int. J. Pediatr. Otorhinolaryngol.
yngol. 72 (March–April (2)) (2006) 177–181.

46 (November (1–2)) (1998) 37–42.
[127] R.E. Black, D.G. Johnson, M.E. Matlak, Bronchoscopic removal of aspirated foreign

[96] D. Gregori, L. Salerni, C. Scarinzi, B. Morra, P. Berchialla, S. Snidero, et al., Foreign
bodies in children, J. Pediatr. Surg. 29 (May (5)) (1994) 682–684.

bodies in the nose causing complications and requiring hospitalization in
[128] L.J. Hoeve, J. Rombout, D.J. Pot, Foreign body aspiration in children. The diag-

children 0–14 age: results from the European survey of foreign bodies injuries
nostic value of signs, symptoms and pre-operative examination, Clin. Otolar-

study, Rhinology 46 (March (1)) (2008) 28–33.
yngol. Allied Sci. 18 (February (1)) (1993) 55–57.

[97] F. Moazam, J.L. Talbert, B.M. Rodgers, Foreign bodies in the pediatric tracheo-
[129] F. Oguzkaya, Y. Akcali, C. Kahraman, M. Bilgin, A. Sahin, Tracheobronchial foreign

bronchial tree, Clin. Pediatr. (Phila.) 22 (February (2)) (1983) 148–150.
body aspirations in childhood: a 10-year experience, Eur. J. Cardiothorac. Surg.

[98] O. Soysal, A. Kuzucu, H. Ulutas, Tracheobronchial foreign body aspiration: a
14 (October (4)) (1998) 388–392.

continuing challenge, Otolaryngol. Head Neck Surg. 135 (August (2)) (2006)
[130] B. Tokar, R. Ozkan, H. Ilhan, Tracheobronchial foreign bodies in children:

223–226.
importance of accurate history and plain chest radiography in delayed presen-

[99] A. Banerjee, K.S. Rao, S.K. Khanna, P.S. Narayanan, B.K. Gupta, J.C. Sekar, et al.,
tation, Clin. Radiol. 59 (July (7)) (2004) 609–615.

Laryngo-tracheo-bronchial foreign bodies in children, J. Laryngol. Otol. 102
[131] S. Blazer, Y. Naveh, A. Friedman, Foreign body in the airway. A review of 200

(November (11)) (1988) 1029–1032.
cases, Am. J. Dis. Child. 134 (January (1)) (1980) 68–71.

Appendix 4
F. Foltran et al. / International Journal of Pediatric Otorhinolaryngology 76S (2012) S12–S19
S19

[132] S.K. Hon, T.M. Izam, C.B. Koay, A. Razi, A prospective evaluation of foreign bodies
[158] A.J. Cataneo, S.M. Reibscheid, R.L. Ruiz Junior, G.F. Ferrari, Foreign body in the

presenting to the Ear, Nose and Throat Clinic, Hospital Kuala Lumpur, Med. J.
tracheobronchial tree, Clin. Pediatr. (Phila.) 36 (December (12)) (1997) 701–706.

Malaysia 56 (December (4)) (2001) 463–470.
[159] H.A. Kadish, H.M. Corneli, Removal of nasal foreign bodies in the pediatric

[133] M. Tomaske, A.C. Gerber, S. Stocker, M. Weiss, Tracheobronchial foreign body
population, Am. J. Emerg. Med. 15 (January (1)) (1997) 54–56.

aspiration in children – diagnostic value of symptoms and signs, Swiss Med.
[160] S. Peridis, I. Athanasopoulos, M. Salamoura, K. Parpounas, E. Koudoumnakis, J.

Wkly. 136 (August (33–34)) (2006) 533–538.
Economides, Foreign bodies of the ear and nose in children and its correlation

[134] D.C. Bloom, T.E. Christenson, S.C. Manning, E.C. Eksteen, J.A. Perkins, A.F. Inglis,
with right or left handed children, Int. J. Pediatr. Otorhinolaryngol. 73 (February

et al., Plastic laryngeal foreign bodies in children: a diagnostic challenge, Int. J.
(2)) (2009) 205–208.

Pediatr. Otorhinolaryngol. 69 (May (5)) (2005) 657–662.
[161] R.E. Wood, M.W. Gauderer, Flexible ﬁberoptic bronchoscopy in the management

[135] S.J. Hong, H.W. Goo, J.L. Roh, Utility of spiral and cine CT scans in pediatric
of tracheobronchial foreign bodies in children: the value of a combined approach

patients suspected of aspirating radiolucent foreign bodies, Otolaryngol. Head
with open tube bronchoscopy, J. Pediatr. Surg. 19 (December (6)) (1984)

Neck Surg. 138 (May (5)) (2008) 576–580.
693–698.

[136] A.O. Ogunleye, O.A. Sogebi, Nasal foreign bodies in the African children, Afr. J.
[162] A.J. Cataneo, D.C. Cataneo, R.L. Ruiz Jr., Management of tracheobronchial foreign

Med. Med. Sci. 33 (September (3)) (2004) 225–228.
body in children, Pediatr. Surg. Int. 24 (February (2)) (2008) 151–156.

[137] M.C. Tong, S.Y. Ying, C.A. van Hasselt, Nasal foreign bodies in children, Int. J.
[163] G. Kadmon, Y. Stern, E. Bron-Harlev, E. Nahum, E. Battat, T. Schonfeld, Comput-

Pediatr. Otorhinolaryngol. 35 (May (3)) (1996) 207–211.
erized scoring system for the diagnosis of foreign body aspiration in children,

[138] E. Bodart, G. de Bilderling, D. Tuerlinckx, J.B. Gillet, Foreign body aspiration in
Ann. Otol. Rhinol. Laryngol. 117 (November (11)) (2008) 839–843.

childhood: management algorithm, Eur. J. Emerg. Med. 6 (March (1)) (1999)
[164] A. Pinto, M. Scaglione, F. Pinto, G. Guidi, M. Pepe, B. Del Prato, et al., Tracheo-

21–25.
bronchial aspiration of foreign bodies: current indications for emergency plain

[139] H.J. Huang, H.Y. Fang, H.C. Chen, C.Y. Wu, C.Y. Cheng, C.L. Chang, Three-dimen-
chest radiography, Radiol. Med. 111 (June (4)) (2006) 497–506.

sional computed tomography for detection of tracheobronchial foreign body
[165] S.P. Yadav, J. Singh, N. Aggarwal, A. Goel, Airway foreign bodies in children:

aspiration in children, Pediatr. Surg. Int. 24 (February (2)) (2008) 157–160.
experience of 132 cases, Singapore Med. J. 48 (September (9)) (2007) 850–853.

[140] J. Ojwang, E.M. Wafula, The experience of foreign body inhalation among
[166] N. Cevizci, A.I. Dokucu, D. Baskin, C.A. Karadag, N. Sever, M. Yalcin, et al., Virtual

children at Kenyatta National Hospital over a ﬁve-year-period, East Afr. Med.
bronchoscopy as a dynamic modality in the diagnosis and treatment of sus-

J. 62 (May (5)) (1985) 323–331.
pected foreign body aspiration, Eur. J. Pediatr. Surg. 18 (December (6)) (2008)

[141] R. Ulku, A. Onen, S. Onat, C. Ozcelik, The value of open surgical approaches for
398–401.

aspirated pen caps, J. Pediatr. Surg. 40 (November (11)) (2005) 1780–1783.
[167] P. Kamath, K.M. Bhojwani, T. Prasannaraj, K. Abhijith, Foreign bodies in the

[142] M. Botma, R. Bader, H. Kubba, ‘A parent’s kiss’: evaluating an unusual method for
aerodigestive tract—a clinical study of cases in the coastal belt of South India,

removing nasal foreign bodies in children, J. Laryngol. Otol. 114 (August (8))
Am. J. Otolaryngol. 27 (November–December (6)) (2006) 373–377.

(2000) 598–600.
[168] F. Pinzoni, C. Boniotti, S.M. Molinaro, A. Baraldi, M. Berlucchi, Inhaled foreign

[143] S. Hussain, R. Pirzada, I.H. Rizvi, S.I. Ali, Radiological ﬁndings in tracheo-bron-
bodies in pediatric patients: review of personal experience, Int. J. Pediatr.

chial foreign body aspiration, J. Pak. Med. Assoc. 38 (December (12)) (1988)
Otorhinolaryngol. 71 (Dec (12)) (2007) 1897–1903.

328–329.
[169] H.I. Yagi, Foreign bodies in the tracheobronchial tree in Sudanese patients, J. R.

[144] M. Ortega, J.E. Sifontes, O. Rosa, P.M. Mayol, R. Rivera, Foreign body aspiration in
Coll. Surg. Edinb. 42 (August (4)) (1997) 235–237.

Puerto Rican children: report of 83 cases, Bol. Asoc. Med. P. R. 78 (July (7)) (1986)
[170] C.Y. Chiu, K.S. Wong, S.H. Lai, S.H. Hsia, C.T. Wu, Factors predicting early

282–286.
diagnosis of foreign body aspiration in children, Pediatr. Emerg. Care 21 (March

[145] M.A. Van Looij, P.P. Rood, L.J. Hoeve, J.A. Borgstein, Aspirated foreign bodies in
(3)) (2005) 161–164.

children: why are they more commonly found on the left? Clin. Otolaryngol.
[171] F. Karakoc, B. Karadag, C. Akbenlioglu, R. Ersu, B. Yildizeli, M. Yuksel, et al.,

Allied Sci. 28 (August (4)) (2003) 364–367.
Foreign body aspiration: what is the outcome? Pediatr. Pulmonol. 34 (July (1))

[146] F. Brkic, S. Umihanic, Tracheobronchial foreign bodies in children. Experience at
(2002) 30–36.

ORL clinic Tuzla, 1954–2004, Int. J. Pediatr. Otorhinolaryngol. 71 (June (6))
[172] S.R. Poole, R.D. Mauro, L.L. Fan, J. Brooks, The child with simultaneous stridor and

(2007) 909–915.
wheezing, Pediatr. Emerg. Care 6 (March (1)) (1990) 33–37.

[147] S. Ibrahim Sersar, U.A. Hamza, W.A. AbdelHameed, R.A. AbulMaaty, N.N.
[173] G.M. Zaytoun, P.W. Rouadi, D.H. Baki, Endoscopic management of foreign bodies

Gowaeli, S.A. Moussa, et al., Inhaled foreign bodies: management according
in the tracheobronchial tree: predictive factors for complications, Otolaryngol.

to early or late presentation, Eur. J. Cardiothorac. Surg. 28 (September (3)) (2005)
Head Neck Surg. 123 (September (3)) (2000) 311–316.

369–374.
[174] M.K. Chung, H.S. Jeong, K.M. Ahn, S.H. Park, J.K. Cho, Y.I. Son, et al., Pulmonary

[148] H. Ozkurt, E. Bahadir, A. Ucgul, C. Altuna, M. Basak, N.M. Cevizci, et al., Compari-
recovery after rigid bronchoscopic retrieval of airway foreign body, Laryngo-

son of multidetector computed tomography-virtual bronchoscopy and conven-
scope 117 (February (2)) (2007) 303–307.

tional bronchoscopy in children with suspected foreign body aspiration, Emerg.
[175] F. Karakoc, E. Cakir, R. Ersu, Z.S. Uyan, B. Colak, B. Karadag, et al., Late diagnosis of

Radiol. (2008), November.
foreign body aspiration in children with chronic respiratory symptoms, Int. J.

[149] L. Versichelen, L. Herregods, R. Donadoni, H. Vermeersch, Anesthesia for foreign
Pediatr. Otorhinolaryngol. 71 (February (2)) (2007) 241–246.

bodies in the tracheo-bronchial tree in children, Acta Anaesthesiol. Belg. 36
[176] H. Puhakka, E. Svedstrom, P. Kero, P. Valli, E. Iisalo, Tracheobronchial foreign

(September (3)) (1985) 222–229.
bodies. A persistent problem in pediatric patients, Am. J. Dis. Child. 143 (May (5))

[150] E.M. Burton, W.G. Brick, J.D. Hall, W. Riggs Jr., C.S. Houston, Tracheobronchial
(1989) 543–545.

foreign body aspiration in children, South. Med. J. 89 (February (2)) (1996)
[177] J.T. Zerella, M. Dimler, L.C. McGill, K.J. Pippus, Foreign body aspiration in

195–198.
children: value of radiography and complications of bronchoscopy, J. Pediatr.

[151] M. Ikeda, K. Himi, Y. Yamauchi, A. Ikui, S. Shigihara, A. Kida, Use of digital
Surg. 33 (November (11)) (1998) 1651–1654.
under the Official Information Act 1982

subtraction ﬂuoroscopy to diagnose radiolucent aspirated foreign bodies in
[178] A.O. Ciftci, M. Bingol-Kologlu, M.E. Senocak, F.C. Tanyel, N. Buyukpamukcu,

infants and children, Int. J. Pediatr. Otorhinolaryngol. 61 (December (3))
Bronchoscopy for evaluation of foreign body aspiration in children, J. Pediatr.

(2001) 233–242.
Surg. 38 (August (8)) (2003) 1170–1176.

[152] I. Pasaoglu, R. Dogan, M. Demircin, A. Hatipoglu, A.Y. Bozer, Bronchoscopic
[179] A.D. Karatzanis, A. Vardouniotis, J. Moschandreas, E.P. Prokopakis, E. Michaili-

removal of foreign bodies in children: retrospective analysis of 822 cases,
dou, C. Papadakis, et al., The risk of foreign body aspiration in children can be

Thorac. Cardiovasc. Surg. 39 (April (2)) (1991) 95–98.
reduced with proper education of the general population, Int. J. Pediatr. Otor-

[153] N.E. Wiseman, The diagnosis of foreign body aspiration in childhood, J. Pediatr.
hinolaryngol. 71 (February (2)) (2007) 311–315.

Surg. 19 (October (5)) (1984) 531–535.
[180] M. Puterman, R. Gorodischer, A. Leiberman, Tracheobronchial foreign bodies:

[154] S. Caglayan, S. Erkin, I. Coteli, H. Oniz, Bronchial foreign body vs asthma, Chest 96
the impact of a postgraduate educational program on diagnosis, morbidity, and

Released
(September (3)) (1989) 509–511.
treatment, Pediatrics 70 (July (1)) (1982) 96–98.

[155] J.S. Janik, J.D. Burrington, E.R. Wayne, J.H. Chang, T. Beach, Foreign body aspira-
[181] S. Cleatus, I. Mohan, R. Ahmed, Tracheobronchial foreign bodies and pulmonary

tion in children, Colo. Med. 83 (January (1)) (1986) 10–11.
atelectasis in children, Ann. Saudi Med. 12 (November (6)) (1992) 582–583.

[156] B.C. Papsin, J. Friedberg, Aerodigestive-tract foreign bodies in children: pitfalls in
[182] K.T. Kavanagh, T. Litovitz, Miniature battery foreign bodies in auditory and nasal

management, J. Otolaryngol. 23 (April (2)) (1994) 102–108.
cavities, JAMA 255 (March (11)) (1986) 1470–1472.

[157] B. Wolach, A. Raz, J. Weinberg, Y. Mikulski, J. Ben Ari, N. Sadan, Aspirated foreign
[183] J.L. Ramirez-Figueroa, L.G. Gochicoa-Rangel, D.H. Ramirez-San Juan, M.H. Vargas,

bodies in the respiratory tract of children: eleven years experience with 127
Foreign body removal by ﬂexible ﬁberoptic bronchoscopy in infants and chil-

patients, Int. J. Pediatr. Otorhinolaryngol. 30 (July (1)) (1994) 1–10.
dren, Pediatr. Pulmonol. 40 (November (5)) (2005) 392–397.

Document Outline

Foreign bodies in the airways: A meta-analysis of published papers