ENT (Otorhinolaryngology) · MU Sofia

51. Foreign bodies in the respiratory tract.

Covers the epidemiology and common objects behind airway foreign bodies, mainly in young children, with a note on why organic items such as peanuts are especially harmful. It then walks through the three clinical stages, a site-by-site table of laryngeal, tracheal and bronchial symptoms, physical signs, radiological secondary signs, and management from first aid to rigid bronchoscopy and postoperative care.

Inside: 1 section · 1 labelled picture · 1 table · 15 flashcards · 4 min

Topic 51 of 52 in the MU Sofia syllabus for ENT (Otorhinolaryngology) (Medicine, Year 4). The free AceMed note covers it in 1 section, about 445 words (4 min of reading), with 15 flashcards.

In this note

  1. Foreign bodies in the respiratory tract.

Foreign bodies in the respiratory tract.

1. Epidemiology and Etiology

A foreign body in the respiratory tract is an inhaled object that becomes lodged in the larynx, trachea, or bronchi, causing partial or complete airway obstruction.

  • Demographics: Most common in children aged 1–3 years (due to lack of molar teeth, immature swallowing coordination, and a tendency to explore with their mouths).
  • Common Objects:
  • Organic: Peanuts (most common), seeds, beans. These are dangerous because they swell and cause local chemical inflammation (vegetal bronchitis).
  • Inorganic: Coins, plastic toy parts, pins, batteries. Dental prostheses in adults.
  • Vegetal Bronchitis: Specifically mention that organic FBs (like peanuts) release fatty acids that cause severe mucosal reaction and fever.
  • The Right Main Bronchus: Always mention why FBs prefer the right side (the 25 degree angle vs 45 degree on the left).
  • Batteries: Disc batteries are a true surgical emergency due to the risk of liquefactive necrosis and perforation within

hours.

2. The Clinical Stages

When an object is inhaled, the patient typically goes through three phases:

  1. 1. Initial Period (Choking/Gagging): Violent coughing, wheezing, and sometimes apnea or cyanosis.
  2. 2. Asymptomatic Interval: The cough reflexes fatigue, and the object settles. This is the most dangerous stage because it leads to a false sense of security and delayed diagnosis.
  3. 3. Complication Stage: Inflammation or infection sets in (pneumonia, abscess, bronchiectasis).

3. Anatomical Sites & Symptoms - The symptoms depend entirely on where the object gets stuck:

Clinical suspicion is key

History:

Sudden coughing episode while eating or playing

4. Physical Signs

  • Unilateral Wheeze: Often mistaken for asthma. If a child has a "first-time asthma attack" that does not respond to bronchodilators, suspect a FB.
  • Decreased Breath Sounds: On the affected side.
  • Mediastinal Shift: During respiration.

5. Radiology

X- rays are helpful, but remember: 80–90% of FBs are radiolucent (they don't show up). You must look for secondary signs:

  • Obstructive Emphysema: The FB acts as a "ball-valve," letting air in but not out. The affected lung remains hyper-inflated even on expiration.
  • Atelectasis (Collapse): The FB acts as a "stop-valve," blocking air entirely.
  • Mediastinal Shift: Away from the affected side (in emphysema) or towards it (in collapse).
  • Neck X-ray (Lateral): Useful for opaque laryngeal or esophageal FBs.

Definitive diagnosis

Rigid bronchoscopy

6. Management

The Gold Standard: Rigid Bronchoscopy.

  1. 1. Emergency First Aid:
  • If the child is coughing, encourage him.
  • If the airway is totally obstructed: Heimlich Maneuver (older children/adults) or Back Blows/Chest Thrusts (infants).
  1. 2. Surgical Intervention:

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