Diagnosis of Upper aerodigestive tract (UADT) Foreign Bodies: A Retrospective Comparison between Plain Film Neck and Laryngeal Endoscopy
Article Sidebar
Main Article Content
Abstract
Introduction : Foreign bodies in the upper aerodigestive tract (UADT) are a common emergency encountered at Buddhasothorn Hospital. Delayed diagnosis or treatment can lead to significant complications. Plain Film Neck is often used as an initial diagnostic tool; however, its accuracy may be limited when the foreign body is radiolucent or obscured by overlying anatomical structures. In contrast, laryngeal endoscopy provides direct visualization of UADT, and also allows for simultaneous removal of foreign bodies.
Objectives : This study aimed to compare the diagnostic accuracy of Plain Film Neck with Laryngeal Endoscopy for detecting foreign bodies in the UADT, to assess the strengths and limitations of each modality, and to propose the most appropriate diagnostic approach for use at Buddhasothorn Hospital.
Methods : A retrospective observational study was conducted on patients presenting with symptoms suspected UADT foreign bodies at Buddhasothorn Hospital between 1 January and 31 December 2024. A total of 111 patients who underwent both Plain Film Neck and Laryngeal Endoscopy were included. Diagnostic results from each modality were compared with the final confirmed diagnosis, which served as the reference standard.
Results : The most commonly found foreign bodies were fish bones, and the base of the tongue was the most frequent site of impaction. Laryngeal Endoscopy demonstrated an accuracy of 100% (95% CI, 96.72–100.00%), with both sensitivity and specificity of 100%. In contrast, Plain Film Neck showed an accuracy of 40.54% (95% CI, 31.29–49.79%), sensitivity of 23.26%, and specificity of 51.47%. Statistical comparison yielded a P-value of 0.90 and a Kappa coefficient of –0.25
Conclusion : Laryngeal endoscopy is appropriate as the primary diagnostic modality for detecting foreign bodies in the upper aerodigestive tract, owing to its high accuracy. Conversely, plain neck radiography demonstrates limited sensitivity and diagnostic accuracy for this condition. In clinical practice, early laryngeal endoscopy should be considered, particularly in patients with clear indicative symptoms, to reduce complications and enhance treatment efficiency.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Singh GB, Varshney S, Bist SS, Gupta N, Bhagat S. Foreign body in the aerodigestive tract: a prospective study. Int J Head Neck Surg. 2011;2(2):63–7.
Passàli D, Lauriello M, Bellussi L, Passàli GC, Passàli FM, Gregori D. Foreign body inhalation in children: an update. Acta Otorhinolaryngol Ital. 2010;30(1):27–32.
Pinto A, Scaglione M, Pinto F, Fonio P, Romano L. Role of radiology in the assessment of foreign bodies in the head and neck. Radiol Med. 2006;111(4):497–506.
Shivakumar AM, Naik AS, Prashanth KB, Shetty KD, Praveen DS. Foreign body in upper aerodigestive tract: a clinical study. Indian J Otolaryngol Head Neck Surg. 2006;58(1):63–8.
Higo R, Matsumoto Y, Ichimura K, Kojima H. Foreign bodies in the aerodigestive tract in pediatric patients. Auris Nasus Larynx. 2003;30(4):397–401.
Rothschild MA, Catalano P, Urken ML. Flexible fiberoptic laryngoscopy: indications, contraindications, and hazards. Ear Nose Throat J. 1997;76(5):314–7.
วิราภรณ์ อัจฉริยะเสถียร, วิวัฒนา ถนอมเกียรติ. การวินิจฉัยสิ่งแปลกปลอมในทางเดินอาหารจากการส่องกล้องตรวจและการส่งตรวจทางรังสีวิทยา. สงขลานครินทร์เวชสาร. 2546;21(1):45–51.
Senar AC, Dinu LE, Artigas JM, Larrosa R, Navarro Y, Angulo E. Foreign bodies on lateral neck radiographs in adults: imaging findings and common pitfalls. Radiographics. 2017;37(2):323–45. doi:10.1148/rg.2017160073.
Chotigavanich C, Tongdee R, Aeimpongpaiboon P, Chongkolwatana C. Accuracy of lateral neck radiography in diagnosis of foreign body ingestion. J Med Assoc Thai. 2018;101(5):637–42.
Luo CM, Lee YC. Diagnostic accuracy of lateral neck radiography for esophageal foreign bodies in adults. AJR Am J Roentgenol. 2020;215(2):465–71. doi:10.2214/AJR.19.21870.
Chen YH, Shomorony A, Drusin MA, Pearlman AN. Consultations for foreign bodies in aerodigestive tract: assessment of diagnostic modalities. Laryngoscope. 2023;133(6):1361–6. doi:10.1002/lary.3033.
