I have read the manuscript “Foreign-body aspiration in an adult” by Qureshi and colleagues,1 and I congratulate the authors on their successful treatment of such a rare case. Yet, I want to remark on some aspects of the manuscript.
In the discussion section, the study by Baharloo and colleagues2 is referenced as stating, “In the adult population, such aspiration is most commonly secondary to unconscious accidental ingestion during general anesthesia, sedation, intoxication, seizures or neurologic disorders affecting the oropharynx.” However, such information is not included in the above-mentioned manuscript. In this retrospective study,2 28 adult patients were examined, and no debilitating factor predisposing to foreign-body aspiration was encountered in any of these patients. In addition, the authors found that the foreign-body aspiration resulting from dental surgery accidents is more common in adults. As a result, they indicated that foreign-body aspiration can occur in the absence of any predisposing factor.
In fact, the factors predisposing to foreign-body aspiration and the type of aspirated object are affected by geographic and cultural differences. Throughout the world, the types and aspiration ratios of aspirated foreign bodies change according to nutrition habits, socioeconomic status, culture and the traditions and customs of the people. Still, serious changes have been observed both in the incidence of predisposing factors and in the nature of foreign bodies aspired. In the last decade, we have encountered an increasing number of cases of turban pin aspiration. The increase in the number of women in Turkey and the Middle East who wear turbans increased the aspiration frequency of pins used for securing the turbans. During the fixation of the turban, the neck is extended and the pins are held between the lips. Speech or laughter can cause the deep aspiration of the pin into the tracheobronchial system. A comprehensive study carried out in Turkey showed that the most common aspired foreign body is the turban pin, which is in keeping with our experiences.3
Many comprehensive studies have determined the characteristics and ratios of predisposing factors for foreign-body aspiration in adults. Limper and colleagues4 determined that impairment of protective airway mechanisms occurred in 25 of 60 cases of adults who aspired foreign objects. Lan5 studied 47 adult patients with nonasphyxiating tracheobronchial foreign bodies and divided them into 4 groups (acute, chronic, uncertain and broncholith) according to the duration of foreign-body aspiration. Of the 29 patients in the chronic group, mechanical ventilation was started in 1 patient who was comatose due to sepsis, and another patient had a seizure after aspiring a foreign object. In the other cases, predisposing factors such as neuromuscular or swallowing disorders, or abuse of alcohol and/or sedatives were not determined. Lai and colleauges6 determined predisposing factors in only 6 patients in their series of 40 cases. In a study by Debeljak and colleauges7 in Slovenia, 62 adults were examined, and it was found that the most common foreign object aspired was pieces of bone. There were no neurologic disorders or loss of consciousness in any of these patients. In the study by Zubairi and colleauges,8 4 adult cases of foreign-body aspiration were presented and no risk factors were determined. Finally, as the results of these studies are taken into account, it seems that many cases of foreign-body aspiration may occur without predisposing factors.
Footnotes
Competing interests: None declared.