Foreign Bodies in Aerodigestive Tract

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Foreign Bodies in Aerodigestive Tract

Pediatric Otolaryngology
Author Credentials 

William O. Collins, MD
Associate Professor
Department of Otolaryngology
University of Florida College of Medicine
Gainesville, FL

Module Summary

Small children have a tendency to place objects in their mouth. Because of relative immaturity of their aerodigestive function they are at an increased risk of aspiration of foreign bodies in the laryngotracheobronchial tree, or ingestion into the esophagus. Since many of these events may not be witnessed directly, it is important for the astute clinician to be alert to the signs and/or symptoms of possible foreign body aspiration or ingestion. Prompt diagnosis and subsequent surgical removal, preferably through the least invasive means possible, remains the predominant treatment. Delays in diagnosis may lead to complications, sometimes with very poor clinical outcomes.

Module Learning Objectives 
  1. Identify factors in the clinical evaluation which might be caused by aspiration and/or ingestion of a foreign body.
  2. Recognize patient and physical factors which might predispose to aspiration and/or ingestion of a foreign body.
  3. Develop treatment strategies for management of tracheal and/or esophageal foreign bodies.

 

Anatomy

Learning Objectives 

To recognize characteristics of the pediatric aerodigestive tract which might predispose to foreign body ingestion.

References 
  1. Agur AM. Grant’s atlas of anatomy. 11th ed. Lippincott Williams & Wilkins, Philadelphia, PA; 2004.
  2. Darrow DH, Holinger LD. Foreign Bodies of the Larynx, Trachea, and Bronchi. In Pediatric Otolaryngology, Fourth Edition. Editors Bluestone CD, Stool SE, Alper CM, et al. Saunders; Philadelphia, PA; 2003:1543-1557.

Pathogenesis

Learning Objectives 

To recognize common foreign bodies which can be aspirated or ingested. 

References 
  1. Lemberg PS, Darrow DH, Holinger LD. Aerodigestive tract foreign bodies in the older child and adolescent. Ann Otol Rhinol Laryngol. 1996;105:267-71.
  2. Rimell FL, Thome A Jr, Stool S, et al. Characteristics of objects that cause choking in children. JAMA. 1995;274(22):1763-766.

Incidence

Learning Objectives 

To recognize the incidence of:

  • Tracheal aspiration of foreign bodies
  • Esophageal ingestion of foreign bodies

 

References 
  1. Lemberg PS, Darrow DH, Holinger LD. Aerodigestive tract foreign bodies in the older child and adolescent. Ann Otol Rhinol Laryngol. 1996;105:267-71.
  2. Kim IA, Shapiro N, Bhattacharyya N. The national cost burden of bronchial foreign body aspiration in children. Laryngoscope. 2015 May;125(5):1221-4.

Patient Evaluation

Learning Objectives 

To perform a comprehensive clinical evaluation in a patient with suspected aspiration or ingestion of a foreign body.

References 
  1. Friedman EM. Caustic ingestions and foreign bodies in the aerodigestive tract of children. Pediatr Clin North Am. 1989; 36(6):1403-410.
  2. Jackson C. Bronchoscopy and esophagoscopy. A manual for peroral endoscopy and laryngeal surgery. Philadelphia: WB Saunders; 1922.
  3. Reilly JS. Bronchoesophagology. In: Snow JB Jr, Ballenger JJ, editors. Ballenger’s otorhinolaryngology head and neck surgery. 16th ed. Hamilton, Ontario: BC Decker; 2003:1511-577.

Imaging

Learning Objectives 

To discuss the role of radiographic imaging in the evaluation of foreign body aspiration or ingestion:

  • Chest Xray
  • Fluoroscopy
  • CT scanning

 

References 
  1. Darrow DH, Holinger LD. Foreign Bodies of the Larynx, Trachea, and Bronchi. In Pediatric Otolaryngology, Fourth Edition. Editors Bluestone CD, Stool SE, Alper CM, et al. Saunders; Philadelphia, PA; 2003:1543-1557.

Treatment

Learning Objectives 

To describe a treatment strategy to evaluate a patient with suspected foreign body aspiration or ingestion. 

References 
  1. Stapleton ER, Augderheide TP, Hazinski MF, et al., eds. BLS [Basic Life Support] forhealthcare providers. American Heart Association; 2001.
  2. Friedman EM. Caustic ingestions and foreign bodies in the aerodigestive tract of children. Pediatr Clin North Am. 1989;36(6):1403-410.
  3. Hawkins DB. Removal of blunt foreign bodies from the esophagus. Ann Otol Rhinol Laryngol. 1990;99:1990:935-40.

Surgical Therapies

Learning Objectives 

To identify surgical therapies for foreign body aspiration:

  • In the tracheobronchial tree
  • In the esophagus

 

References 
  1. Darrow DH, Holinger LD. Foreign Bodies of the Larynx, Trachea, and Bronchi. In Pediatric Otolaryngology, Fourth Edition. Editors Bluestone CD, Stool SE, Alper CM, et al. Saunders; Philadelphia, PA; 2003:1543-1557.

Case Studies

  1. A 3 year old female has been treated for persistent wheezing. Upon a review of her pediatrician’s records, it is noted that she consistently has had new onset right sided wheezing over the last 4 weeks. There was no antecedent illnesses. A chest Xray has been ordered. What findings on the chest Xray would raise suspicions for an aspirated foreign body?  What would be the indications for operative intervention? Describe a surgical strategy to diagnose and remove an aspirated foreign body.
  2. A 6 year old boy is rushed to the ED with acute onset of stridor after he was noted to have difficulty breathing while eating at a picnic.  What is the differential diagnosis? What types of foreign bodies are most likely to cause acute airway obstruction? Describe a treatment strategy to diagnose the cause of this child’s airway distress, including possible surgical therapies.

Complications

Learning Objectives 

To recognize potential complications of unrecognized or untreated foreign bodies in the trachea or esophagus. 

References 
  1. Friedman EM. Caustic ingestions and foreign bodies in the aerodigestive tract of children. Pediatr Clin North Am. 1989;36(6):1403-410.
  2. Holinger LD. Management of sharp and penetrating foreign bodies of the upper aerodigestive tract. Ann Otol Rhinol Laryngol. 1990;99:684-88.
  3. Marks SC, Marsh BR, Dudgeon DL. Indications for open surgical removal of airway foreign bodies. Ann Otol Rhinol Laryngol. 1993;102:690-94.
  4. Zaytoun GM, Rouadi PW, Baki DHA. Endoscopic management of foreign bodies in the tracheobronchial tree: predictive factors for complications. Otolaryngol Head Neck Surg. 2000;123:311-16

Review

Review Questions 
  1. What are the peak ages of children at risk of aspiration of an airway foreign body?
  2. What types of foreign bodies are most at risk of aspiration?
  3. What imaging modalities are most useful in identifying an aspirated foreign body?
  4. What are the indications for bronchoscopy for a suspected airway foreign body?
Resources 

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  1. Annual Meeting Webcast (AMW):