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Foreign Body Aspiration

The peak incidence of foreign body aspiration is six months to four years, and clinical manifestation is sudden onset. Sudden onset of coughing suggests a foreign body aspiration. If it is extrathoracic you are likely to hear stridor and a croupy cough. If it has gone down intrathoracic you are going to see more cough and wheezing. Diagnosis: extrathoracic, x-rays are helpful if it is radiopaque and one key link that I think is relatively likely to show up on exams is what happens if you see a coin? And what you will see is that coins in the sagittal plane are in the larynx.

 The way you can remember that is the tracheal rings have an opening in front so that if a coin is going to slide down into the trachea it’s going to be pointed in this direction. So when you do an x-ray you are going to see it on end, whereas if it’s in the esophagus it’s going to be in the coronal plane. So nice little tip there if you see an x-ray with a coin in it.

Intrathoracic: 80% of kids with intrathoracic foreign body will have abnormal x-rays and you may see a variety of things: hyperinflation, atelectasis, pneumonia, especially if they have had this for some time pneumonia is much more likely to develop. You can do inspiratory/expiratory films but it’s very difficult obviously to get a small child to cooperate with those, and the other option is bilateral decubiti film. What you see on this film is this is an inspiratory film that is certainly suggestive of having some hyperinflation on this side. This side is much more lucent than this side, seems to occupy more volume. Expiration, it’s really quite clear that the right middle lobe and right lower lobe are quite inflated and so this is consistent with a foreign body in that area.

Management of these: extrathoracic; if you have partial obstruction don’t try to dislodge it because it may lead to complete obstruction and you want to arrange for emergency bronchoscopy. Intrathoracic, you just need to arrange for bronchoscopy.

Okay, our last section is on hearing loss. Two major forms that we’ll have is conductive hearing loss and then sensorineural hearing loss, but you also can see mixed forms as well. Conductive loss is caused by interference with transmission of sound through the external canal, through the tympanic membrane.

Conductive hearing loss can be either acquired or inherited. Acquired is much more common. Tends to be transient and is often mild to moderate hearing loss. Most often due to things like earwax or sometimes middle ear effusion. If you see more significant loss or a more chronic loss, it’s generally caused by damage to the tympanic membrane and/or the ossicles. So things like chronic perforation, which we mentioned before, cholesteatoma, otosclerosis, or more.

Sensorineural hearing losses can be acquired or inherited. The acquired ones may be infectious so TORCH infections in newborns, particularly Rubella, can cause sensorineural hearing loss. Bacterial meningitis, especially H. flu can cause hearing loss. And then medications, aminoglycosides, diuretics are two of the most notorious but there are others as well. And then generally not a problem in kids but maybe later on, certainly for "baby-boomers."