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Objectives: Fishbone ingestion is a common problem worldwide, and the first step for managing this condition is to locate the fishbone precisely. However, until now, no study has analysed the true location of fishbone and its associated factors. Thus, this study identified the factors predicting the true location of fishbone and subsequently attempted to provide a management algorithm for fishbone ingestion., Patients and Methods: This retrospective study was carried out at St Martin De Porres Hospital, Taiwan, between January 2015 and January 2016. All patients were diagnosed as having fishbone ingestion within the pharynx and underwent fishbone removal., Results: This study included 198 consecutive patients with a mean age of 43.1 years (range: 1-84 years). The sensitivity of lateral neck radiography in the diagnosis of fishbone in the pharynx was only 22%. The fishbone locations were as follows: the tonsil in 72 (36.4%) patients, the tongue base / vallecula in 112 (56.6%) and the hypopharynx in 14 (7.0%). Multiple logistic regression analysis showed that patient age and fishbone length were significant independent risk factors associated with the true location of fishbone ingestion. Among all patients, fishbone was removed transorally under direct vision in 73 (36.9%) patients and using flexible nasopharyngoscopy in 125 (63.1%) patients., Conclusion: Patient age and fishbone length are important independent factors associated with the location of ingested fishbone. Lateral neck radiography is not beneficial for diagnosing fishbone ingestion within the pharynx. Flexible nasopharyngoscopy, by contrast, is an important method for the diagnosis and treatment of fishbone ingestion within this location.

Background: Button batteries represent a distinct type of foreign body. Serious complications can be resulted, particularly when the battery is impacted in the esophagus. The potentially detrimental effects of button battery ingestion have often been overlooked in Taiwan. We surveyed patients following button battery ingestion to define the characteristics and outcomes of this population., Methods: The records of 25 patients with button battery ingestion that had been reported to the Taipei Veterans General Hospital Poison Control Center from July 1988 through January 1998 were retrospectively reviewed., Results: Button battery ingestion occurred most commonly in male children (N=20; 80%) and children under 3 years of age (N= 19; 76%). Most children were asymptomatic (N=22; 88%). Two children suffered abdominal pain, and one suffered dyspnea and stridor. Reported complications included black stools (N=3) and tracheoesophageal fistula formation (N= 1). Two children underwent endoscopic battery removal, and batteries passed the entire gastrointestinal tract in all other subjects. The interval between battery ingestion and passage when documented (N= 16) was never more than 5 days., Conclusion: Most ingested batteries passed through the gastrointestinal tract without any adverse effects. An initial roentgenogram should be obtained promptly to determine battery location and diameter, and the battery's chemical composition should be determined when possible. Esophageal impaction of the batteries requires emergency endoscopic or surgical removal. For patients without esophageal impaction, conservative intervention is recommended in the absence of symptoms and signs of injury.

This study examined 11,333 rigid endoscopy procedures performed in the Department of Otolaryngology, National Taiwan University Hospital, during a 27-year period from 1970 to 1996. Among these cases, 3217 were performed to remove foreign bodies from the airway (459 cases, 14.3%) and esophagus (2758 cases, 85.7%). Retrospective analysis of these data revealed that peanuts (217 cases) and animal bones (1184 cases) were the most frequent foreign bodies encountered in the airway and esophagus, respectively. The successful rate of removal of these foreign bodies was 99.9% (3213/3217). The complication rate was only 0.2% (8/3217), and the mortality rate was less than 0.1% (2/3217). On the basis of these results, we conclude that foreign bodies in the airway and esophagus can be removed safely under direct visualization through rigid endoscopy with relatively few complications. A significant finding in this study is the declining trend in the number of cases in recent years. Despite the decline in the number of procedures, endoscopic removal of foreign bodies remains as a vital skill of the aerodigestive tract surgeon.

Objectives: Foreign body aspiration into the lower airway in adults is uncommon. We designed this study to investigate the clinical presentations, precipitating factors, management choice, and complications of foreign body aspiration in Chinese adults., Patients and Methods: We analyzed 43 consecutive adult patients with foreign body aspiration between February 1980 and December 1995 from the medical record registry and cross index system of a tertiary medical center., Results: The most common symptoms are chronic cough, hemoptsis, fever, and dyspnea. Only three patients (7%) presented with choking. Chest radiograph demonstrated the foreign body in nine cases (21%). The most common foreign body was bone fragments (21/43, 49%). Lodgment is more common in the right, especially the right intermediate bronchus and basal bronchus. Three patients were also diagnosed as having lung cancers. Precipitating factors include CNS dysfunction, facial trauma, intubation, dental procedure, and underlying pulmonary diseases. Flexible fiberoptic bronchoscopy removed the foreign body in 25 cases (58%) during the first attempt and 32 cases (74%) in total. Complications include obstructive pneumonitis (including one case of actinomycosis infection), atelectasis, bronchiectasis, lung abscess, and lung torsion (two cases)., Conclusion: The nature of foreign body in Chinese adults was different from the Western adults. The initial clues to foreign body aspiration in adults are usually obscure or indirect. We suggest flexible fiberoptic bronchoscopy as the first-line approach. Follow-up bronchoscopy and chest radiograph are recommended to detect chronic complications or coexisting lung cancer.

Aspiration of foreign bodies into the bronchial tree is infrequently seen in adults. We reviewed 40 such cases during an 8-year period at Chang Gung Memorial Hospital, Kaohsiung. Only six patients had underlying conditions that contributed to the aspiration of foreign bodies. A positive history of aspiration was found in 18 patients (48%). Clinical manifestations were nonspecific. Chest roentgenograms were useful in 11 of the 40 patients. Bronchoscopic findings were classified into three groups: foreign bodies in the bronchial tree without granulation tissue, foreign bodies in the bronchial tree with marked granulation tissue and foreign bodies embedded in the granulation tissue. The diagnoses and removal of foreign bodies were successful in 37 patients (92%) using grasping forceps or biopsy forceps and in one patient using basket type grasping forceps. Complications of bronchoscopy were rare and not serious. The diagnosis of occult foreign bodies is often difficult and demands a high index of suspicion. Removal of endobronchial foreign bodies is usually possible with a flexible fiberoptic bronchoscope and has a high success rate.

The presentations of 47 adult patients with a non-asphyxiating tracheobronchial foreign body were reviewed. The duration of residence of the foreign body was 1 week or less in nine ("acute group"); 1 month or more in 29 ("chronic group"), uncertain in four ("uncertain group"); and the foreign body was a broncholith in five patients ("broncholith group"). In the chronic and uncertain groups, no precipitating factor was found and bone was the most common foreign body. In the chronic group, a choking history was obtained before bronchoscopy in only 15 patient. Clinical manifestations and roentgenograms were nonspecific in most cases, except in the acute group. In the chronic group, the mean duration of residence of the foreign body was 25.8 months. The diagnosis was delayed due to absence of a choking history and invisibility of the foreign body on chest films in 12, due to patient's ignorance in 14, due to physician's ignorance in 1, and due to previous unsuccessful retrieval attempts in 2 patients. The main indication for bronchoscopy in the acute group was a choking history or a visible foreign body on the chest film. In the chronic group, a choking history or conditions leading to "suspicion of an endobronchial lesion" were the main indications. The foreign body was removed with a fibreoptic bronchoscope in over 90% of patients. It is concluded that the most important diagnostic factor is a high clinical index of suspicion and that flexible fibreoptic bronchoscopy provides a valuable therapeutic option in selected conditions.