 Nasal

 Pharynx and esophageal

 Larynx and tracheobronchial

 Inert

 Hygrophilic

 Corrosive
 Decongestion
 Extraction
* instrumentation
* magnets
* superglue
* oral positive pressure
* fogarty baloon
Repeated manipulation is to be avoided
 Swallowed
 Expectoration
 Rhinolith formation
 Tracheo bronchial tree
 Peanuts, seeds, vegetable matter

 Coins , pins, button batteries.

 M.C around 3 yrs
 Risk factors:
Lack of rationale
Lack of molars
Poor grinding & swallowing mech
Immature glottic closure
 Non spherical : < 1.5 inches/38.1mm
 Spherical : <1.75 inches/44.5mm
 Glottic impaction – laryngospasm
 Large and thin objects are more prone to
lodge
 Emergency clearing procedures (hemlich’s
manouevre)
 Finger sweeping - contraindicated
 Penetrating  Irritating
 Non penetrating  Non irritating
- only a
small proportion
gets impacted
 Suspicion of airway foreign body mandates a
bronchoscopy , whereas esophageal FB
removal depends on the elapsed time since
ingestion and the location and type of object.

 Upper esophageal FB can cause airway

compromise.
 Esophageal FB- twice as common as airway
FB.
 10-20% of esophageal FB require scopic
removal.
 <1%- thorocotomy.
Uncommon in peadiatric population.
Eosinophilic esophagitis.
Esophageal strictures.
Nissen fundoplication.

Cough, dyspnea, stridor, choking


Vomiting,drooling,dysphagia,odynophagia,
emesis,food refusal,chestpain

physical exam

Decreased lung sounds, wheezing, crackles,
tachypnea, hypoxemia,

Drooling, poor feeding, choking
 Three clinical phases
1. Stage of impaction
2. Stage of relaxation
3. Stage of complication
. 92% cases have +ve h/o ingestion
. 47% are asymptomatic
 check valve effect
 Ball valve effect
 stop valve effect

 Prolonged expiratory phase – bronchial fb

 X ray STN AP & Lat
 CXR PA view
 Only 11% of airway fb are radio opaque.
 u/l emphysema, hyper inflation, localised
atelectasis ,infiltrates
 Expiratory view, lat decubitus view
 Radio opaque Foreign bodies and classical
teaching
 CT and virtual bronchoscopy
 Flexible bronchoscopy
 h/o ingestion / witness
 Imaging
 Signs n symptoms
 High index of suspicion
----
Airway foreign body
History Witnessed aspiration
Cough, dyspnea,
Physical Stridor, Refractory asthma,
examinati Decreased lung sounds,
on wheezing, crackles,
tachypnea, hypoxemia,
imaging unilateral emphysema or
hyperinflation, localised
atelectasis or infiltrate
treatment If adequate suspicion,
proceed immediately to rigid
Esophageal foreign
body
Witnessed ingestion
Vomiting,drooling,dys
phagia,odynophagia,e
mesis,food
refusal,chestpain
Drooling, poor
feeding, choking
widened preverteberal
shadow,l oss of
lordosis.
symptomatic children
Vs
Location:
 Tracheal FB require more urgent intervention
than bronchial
 80 – 90 % is bronchial
 Esophageal FB lodge at four physiological
narrowings
 Asymptomatic children
 Non sharp , Inert FB
 Recent ingestion <24 h
 Location: mid or distal esophagus
 No h/o esophageal disorders
 Esophagoscopy: Intubation minimises risk of
aspiration and airway compression
 Bronchoscopy :
 Spontaneous ventilation with negative
pressure inhalation
 Positive pressure ventilation
 Manual jet ventilation
 Mask induction
 Direct laryngoscopy
 Rigid bronchoscope insertion
 Connection of ventilator port
 Foreign body visualisation
 Appropriate size forceps introduction
 Forceps, FB, brochoscope moved as a single
unit
 Repeat check bronchocopy
 Endo tracheal intubation
 Rigid esophagoscope introduction
 Foreign body visualisation
 Grasping FB with forceps
 Forceps, esophagoscope, FB moved as a
single unit
 Check esophagoscopy
 Retrieval with larnygoscope and magills
forceps - for proximal FB
 Sedation and anesthesia – relaxation of
esoph.sphincter,- object can migrate in to
stomach
 FB in stomach – observed*
 The average intestional transit time is 3.8
days
 Uncomplicated procedure – schedule for
review – discharge.
 Post op x-ray.
 Monitor T P R,
 Post op antibiotics and steroids
Bronchoscopy : Esophagoscopy :
 failure to retrieve  Failure to retrieve
 Laryngeal edema  Mucosal injury
 Pneumothorax  Bleeding
 Pneumomediastinu  Perforation
m  mediastinitis
 Subcut emphysema