This article is one of many within this issue that addresses a variety of ENT emergencies. The article outlined the stepwise process of assessing and managing a child with a suspected foreign body (FB) inhalation. Nuts, seeds and vegetable matter comprise the majority of FBs (67-84%), with small toys (or objects) comprising the remainder. They rightly remind the reader that inhalations can present in a multitude of ways, from an unwitnessed event and recurrent lower respiratory tract infections to the more serious and more proximal obstructions with respiratory distress and stridor. Chest X-rays still remain the investigation of choice, the sensitivity and specificity of which is 61% and 77%, respectively for identification of the FB and 75% of films will have abnormal findings which they describe. The authors then talk through the preoperative considerations, including the equipment (to be set up pre-anaesthetic) and type of forceps appropriate for each type of FB. They outline the preferred anaesthetic, including gas induction, spraying the cords with local anaesthetic and IV maintenance. Although they include a table for age groups and appropriate size of Storz bronchoscope, an image of a bronchoscope set would have been useful to remind readers of the setup, since the equipment is so infrequently (but fortunately) used in suburban settings. The authors also include helpful tips if you’re stuck and the FB won’t move – using a balloon catheter to pass beyond the object, inflate and draw proximally, or alternatively, push the FB into a bronchus, so at least ventilation of some sort can be achieved. The use of adrenaline patties to reduce peri-FB oedema may also be helpful. They also outline the possible complications. Overall this was a concise and helpful reminder of how to approach these emergencies given how infrequently they are seen in the general ENT practice.

Paediatric airway foreign body.
Ambrose SE, Raol NP.
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Suzanne Jervis

FRCS (ORL HNS), Shrewsbury and Telford Hospitals, NHS Trust, UK.

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