Foreign Bodies in Air Way

HOLY FAMILY HOSPITAL RAWALPINDI

Introduction
 Common problem in otolaryngology  It is one of the most common cause of sudden death in

children
 Most common foreign bodies are food products(peanuts)

Introduction
 Right main bronchus is most common site of impaction
 Rigid bronchoscopy is the best and safe method of foreign

body removal in expert hands

Classification of Foreign Bodies

 Exogenous

 Endogenous

Exogenous foreign bodies
Organic (vegetable) Inorganic (non-vegetable)

Peanuts
Betel Nut Popcorn Seeds

Whistle
Stone Screws Pins

Organic foreign bodies are dangerous because these produce severe chemical bronchitis

Endogenous Foreign Bodies
 Saliva and mucopus inhalations in neuromuscular

disorders  During surgery aspiration of blood and debris into lungs

Percentage Age Incidence of Foreign Bodies
%Age Age

76%
18% 6%

Less than 4 years
4 to 14 years More than 14 years
(HOLINGER AND HOLINGER)

Clinical Features
Depend on:
 Nature

 Location of foreign body
 Degree of bronchial obstruction

Symptoms

 Young child h/o choking with eating or
 Slipping of object into the mouth  Severe coughing

 Patient may become dyspnoeic or apnoiec
 Sharp object may cause pain or haemorrhage

Signs

 Large foreign bodies in trachea:

signs are bilateral  Unilateral wheeze is the usual presentation accompanied with chest crepitations  Presentation can be of complete or incomplete bronchial obstruction

Two main presentations
 Obstructive emphysema
 Lung collapse(atelectasis)

Signs
 Incomplete bronchial  Complete bronchial

obstruction:(emphysema)  Wheeze  Hyper resonant chest  Decreased breath sounds

obstruction(atelectasis)  Dull chest  No breath sounds

Differential Diagnosis
 Pneumoniae
 Laryngotracheobronchitis  Atelectasis

Investigations
 X-ray neck lateral view
 Chest x-ray on expiration  Fluoroscopy  Ct scan

 Bronchography
 Radio nuclide lung scan  Diagnostic bronchoscopy

Pre-requisite for Bronchoscopy
 Informed written consent from patients attendats  Senior available anaesthetist surgical staff should

perform  Avoidance of sub optimal conditions of night time  With long history of inhalation it should be done under antibiotics cover  Correct size of bronchoscope should be used

Bronchoscope Size Used
Age Infants 1-3 years Size of bronchoscope 3-5 mm 4 mm

3-7 years
8-12 years Over 12 years

5 mm
6 mm 7 mm

Indications of Bronchoscopy

Diagnostic
 HAEMOPTYSIS OF UNKNOWN CAUSE

 SUSPECTED BRONCHIAL OBSTRUCTION
 OBSECURE CHESTSYMPTOMS

Indications
Therapeutic
 Foreign Bodies
 Bronchial Toilet  Paliation

Bronchoscopy
 Procedure

Complications of Anaesthesia
 Vocal Cord Damage
 Tracheaomucosal Abrasions  Lung Collapse

 Respiratory Arrest
 Cerebral Anoxia

Complications of Bronchoscopy
 Massive bleeding
 Laryngospasm  Bronchial rupture

 Pneumothorax
 Cardiac arythmias

Conclusion
 The aspiration of foreign body in tracheobroncheal tree is a

serious matter  We must have a high index of suspicion in a child who presents with sudden respiratory distress or paroxysmal cough without fever

Conclusion
 Absence of classical history & signs & symptoms does not

rule out suspicion of foreign body inhalation  History of repeated chest infections especially failure of medical treatment to relieve recurrent pneumonia should raise the suspicion of f.B.  Small objects with danger of inhalation should be kept away from children

Case No.1
This four year old girl presented with severe strider. She gave history of aspirating piece of beetle nut. On examination she had strider, accessory muscles of respiration were active with trachial tug..Breath sounds were reduced on right side,Chest X-ray showed expiratory emphysema on right side with mediastinum shifted to left.Bronchoscopy was done under general anesthesia and foreign body was retrieved from right lobe bronchus.

Case No. 2
This little girl was alone in the room and suddenly developed a choking spell and then settled. She was brought to hospital. On examination she was comfortable.Auscultati on revealed reduced breath sounds on right side with ronchi. Xray chest showed expiratory emphysema on right side. A piece of peanut was removed on bronchoscopy

Case 3
This twenty year old boy was having three year history of cough.Recently he started with hemoptysis . Chest xray revealed metalic foreign body in right bronchus which was removed by rigid bronchoscopy.

Foreign body

Role of Tracheostomy
 To reduce dead space and work of breathing
 To prevent postoperative airway obstruction due to

subglottic edema  As an approach

How To Scope
 Check the equipment before starting the anesthesia
 Locate the foreign body  Make a plan for removal

Tips
 Scope on suspicion
 Scope in case of acute wheeze of unknown cause in infants

and children  Scope in case of chronic wheeze in children which does not settle with all possible medical treatment