What Is the Typical Presentation of Foreign Body (FB) Aspiration?

The majority of FB aspirations in small children are witnessed. Early symptoms include drooling, tachypnea, retractions, stridor, wheezing, and/or use of accessory muscles. Children with greater than 24 hours of symptoms may present with tachypnea, fever, and signs of respiratory distress.

What Is the Most Common Type of Aspirated FB?

Foods such as nuts and seeds, as well as other organic material in the bronchial tree, are the most commonly aspirated objects, but any small object, such as a bead, can be accidently inhaled when a toddler places it in his or her mouth. Because of their inability to coordinate swallowing and breathing movements, children under the age of four should not be fed any kind of small nut.

It is interesting to note the types of foreign bodies anesthesiologists don’t see presenting for urgent bronchoscopic removal. Larger items such as hot dogs, balloons, and plastic wrappers can seal off the airway. They are not easily dislodged by either the Heimlich maneuver or coughing. Aspiration of these objects is associated with a high fatality rate.

How Does the Physical Exam Help to Locate the FB in the Airway?

The presence of stridor or wheezing may help you to determine the location of the FB. Stridor is produced by turbulent airflow through an obstructed airway. Inspiratory stridor usually indicates obstruction at or above the larynx. Expiratory or biphasic stridor generally points to obstruction below the larynx.

Decreased breath sounds are a very common finding and may help to determine the laterality of a bronchially placed FB. The incidence of right-sided foreign bodies is higher than foreign bodies in the left-sided bronchial tree. The absence of breath sounds over a portion of lung provides a clue to where you are likely to find the FB obstructing the airway: high in the hypopharynx obstructing the glottis opening, at the carina obstructing the mainstem bronchi or in the esophagus compressing the trachea.