Foreign Bodies in the Airways

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Introduction

Children (most commonly) may aspirate pieces of play objects or food items accidentally into the airway. This may present as serious emergency with imminent asphyxia. 

Clinical Features

  • If object is arrested at laryngeal level, acute upper respiratory tract obstruction with difficulty in breathing and stridor may occur immediately or progressively
  • Initial dyspnoea and cough may subside if the object passes down, but symptoms may return later
  • Sharp objects (e.g. fish bones or pins) may be impacted on the vocal cord leading to oedema and progressive obstruction
  • In severe cases, stridor, severe cyanosis and imminent asphyxia requiring immediate intervention to prevent a fatal outcome may occur
  • Small objects such as seeds may transverse the larynx and become arrested in the trachea or bronchus. Vegetables such as peanuts may cause inflammatory reactions such as pneumonitis. 
  • Two way stridor often occurs with tracheal foreign bodies
  • In the lower airways objects may remain for long periods, with unexplained chest symptoms

Differential Diagnoses

  • Acute laryngitis 
  • Acute laryngeal oedema
  • Bronchopneumonia
  • Pulmonary tuberculosis

Complications

  • Life-threatening asphyxia
  • Lung collapse and atelectasis

Investigations

  • Radiograph of neck and chest

Treatment Goals

  • To maintain the airway and adequate respiratory function
  • Remove the foreign object as expeditiously as possible

Non-drug Treatment

  • Immediate removal under anaesthesia by direct laryngoscopy or bronchoscopy as appropriate
  • Tracheostomy where necessary top maintain airway

Drug Treatment

  • Antibiotic prophylaxis if necessary (for 3 days) 
    • Amoxicillin
    • Child
      • 6-12 years: 250 mg orally 12 hourly
      • under 5 years: 125 mg orally 12 hourly
  • Steroids 
    • Hydrocortisone (for pneumonitis)
    • Child 
      • 1 month - 1 year: initially 25 mg by intravenous or intramuscular injection q8hr
      • 1 - 6 years: initially 50 mg q8hr
      • 6 - 12 years: initially 100mg q8hr
      • 12 - 18 years: initially 100 - 500mg q8hr
      • adjusted in all age groups according to response

Supportive Measures

  • Oxygen
  • Steam inhalation/nebulizer

Prevention

  • Vigilant supervision of young children