(Dr. Behzadi replies)
=====================

* Abdollah Behzadi

It is with pleasure that we see our case report1 in the *Canadian Journal of Surgery* (*CJS*) has generated considerable interest. We thank Dr. Karapolat for an informative letter.

The diagnosis of foreign-body aspiration (FBA) in adults, which includes the geriatric population, is perhaps underreported. To truly determine the incidence of FBA in adults and identify the predisposing factors, one needs to include the examination of the records of patients who did not survive the occurrence. Aspiration pneumonia is a common and often terminal event in debilitated patients and is encountered frequently at autopsy.2 Moreover, patients in whom complications of overlooked FBA develop should also be included in any analysis. A study of 59 cases of foreign-body aspiration diagnosed on biopsy or resection specimens3 showed the presence of predisposing factors in most patients. Therefore, any conclusion on the incidence of predisposing factors based on the outcomes of alert and oriented patients who seek medical care after a suspected FBA such as a turban pin aspiration should be viewed with caution.

In our discussion, the reference to Baharloo and colleagues4 should have mentioned the lack of identifiable predisposing factors in some cohorts while emphasizing the known risk factors for FBA such as impairment of protective airway mechanisms.5

The objective of our case report for the general readership of *CJS* was mainly to demonstrate that the aspiration of a large object in an adult could potentially be tolerated for an extended period of time, and that the management of such a problem can be quite challenging.

## Footnotes

*   **Competing interests:** None declared.

## References

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