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 emergencies with imminent asphyxia.

The object if arrested at laryngeal level causes acute upper respiratory obstruction.

Sharp objects such as fish bone or pins may be impacted on the vocal cord and the resulting oedema causes progressive obstruction.

Small objects such as seeds may traverse the larynx and become arrested in the trachea or bronchus lower down.

Vegetables such as peanuts often cause
severe reaction in the lungs with pneumonitis

Clinical features

Difficulty in breathing with stridor occurs immediately or progressively.

Initial dyspnoea and cough may subside if the object passes down.

Symptoms gradually return later
Severe cases: stridor and severe cyanosis
with imminent asphyxia requiring
immediate intervention to prevent a fatal outcome.

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
  • Pulmonary tuberculosis
  • Bronchopneumonia

Complications

  • Life-threatening asphyxia
  • Lung collapse and atelectasis

Investigations

  • Radiograph of neck and chest

Treatment objectives

  • 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
    to maintain airway

Drug treatment

Antibiotic prophylaxis if necessary (for 3 days)

Amoxicillin.

  • Child:
    • 6-12 years: 250mg orally every 12 hours;
    • under 6 years: 125 mg orally every 12 hours

Steroid

Hydrocortisone (for pneumonitis)

  • Child:
    • 1 month – 1 year: initially 25 mg by intravenous or intramuscular injection every
      8 hours;
    • 16 years: initially 50 mg every 8 hours;
    • 6 – 12 years: initially 100 mg every 8 hours;
    • 12 – 18 years: initially 100 – 500 mg 3 times daily, adjusted in all age groups according to response

Supportive measures

  • Oxygen
  • Steam inhalation/nebulizer

Prevention

  • Vigilant supervision of young children

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