URTObstruction - Diseases
Introduction Physical Examination Differential Diagnosis Specific Diseases Epiglottitis Viral croup Foreign body aspiration Clinical Diagnosis Management Retropharyngeal abscess References Other Lectures		Over 3000 people die from foreign body (FB) aspiration each year and over half of these are children less than 4 years old. FB aspiration is the most common cause of in-home accidental death in children under 6 years old. It usually occurs in the 1 to 4-year-old but may occur as young as 6 months. A second peak around 10 years of age has been reported. The most common FBs are peanuts and sunflower seeds, but almost any conceivable type of object (metal, plastic, food, grass) may be aspirated. Under 1 year, eggshell aspiration during feeding is a common cause. The patient may present with a variety of signs depending on the location of the FB and the degree of obstruction: wheezing, persistent pneumonia, stridor, coughing or apnea. Recurrent stridor and/or wheezing may indicate a FB which is changing position within the airway - stridor when it is proximal and wheezing when it moves more distally. Stridor from a FB implies a location in the larynx, trachea or mainstem bronchus. The usual location is in a mainstem bronchus, often the right, producing cough, unilateral wheezing or stridor and classic xray signs. Laryngeal and tracheal FBs are less common but not rare, constituting 10 to 15% of all FBs. The patient with persistent stridor and croup who does not improve over 5 to 7 days may have a FB in the upper airway. Classically, symptoms will occur acutely (choking, coughing, gagging) but usually subside with passage of the FB into the smaller airways. This, in turn, may lead to pneumonia, atelectasis or wheezing. This triphasic course of symptoms - acute, latent asymptomatic period and delayed wheezing or stridor - is classic for mainstem bronchus FBs. It has been reported that only 25% of patients who have aspirated a FB present within 24 hours of the event. As many as one third of the aspirations may not be witnessed or remembered by the parent. Often, there is no history of the aspiration, or it is obtained only in retrospect. The physician must have a high index of suspicion of a FB. Upper esophageal FBs can cause stridor. They may also cause dysphagia or failure to thrive, especially with a longterm radiolucent FB, such as an aluminum "pop-top". However, even in the absence of dysphagia, the possibility of an esophageal FB should be considered in the patient with stridor. Return to top of page