Chapter 150

The death toll in the United States from foreign body aspiration among all age groups has remained at approximately 3000 per year for the past 20 years.1 The mortality rate following foreign body aspiration is estimated at 1 to 2 percent. The most likely cause of death is complete airway obstruction, generally at the level of the larynx or trachea. Globular objects such as hot dogs, candies, nuts, and grapes are the most commonly aspirated food objects.2 Rubber balloons and toys are the most commonly aspirated nonfood objects.2 The majority of foreign body aspirations (> 70 percent) occur in children, most of whom are younger than 3 years of age.1

The management of airway foreign bodies requires specific expertise and training. Airway foreign bodies must be managed by an Otolaryngologist or other qualified physician, depending on the institution, with experience in airway endoscopy and the knowledge to deal with potential complications related to airway obstruction. The morbidity and mortality associated with airway foreign body retrieval has greatly declined due to the development of safe endoscopic techniques, rod-lens telescopes, and optical forceps.

The burden of proof lies in the physician’s hands in order to diagnose airway foreign bodies. Keep in mind that information gained from the history, physical examination, and radiologic studies may not clearly define the presence of a foreign body.3 Thirty-three percent of airway foreign body cases are neither observed nor suspected. The physical examination may be normal in up to 39 percent of patients. Radiographic studies may be normal in up to 20 percent of the patients. The only definitive test when considering the diagnosis of an airway foreign body is endoscopy to evaluate the entire laryngotracheobronchial tree.

The airway is divided into three anatomic regions: the larynx, the trachea, and the bronchi. The laryngeal aditus is formed by the epiglottis anteriorly, the aryepiglottic folds laterally, and posteriorly by the corniculate cartilages and upper border of the arytenoid muscle. The larynx extends from the level of the aditus to the lower border of the cricoid cartilage, where it is continuous with the trachea.4 The infant larynx is located higher in the neck than the adult larynx. The cricoid cartilage descends in the neck through childhood. Due to the superior position of the infant larynx, the epiglottis is located with the tip often resting on the soft palate.5 The infant larynx is approximately one-third the size of the adult larynx. Laryngeal foreign bodies are most common in infants due to the small size of the inlet.

The trachea begins at the lower border of the cricoid cartilage, extending downward from about the level of the sixth cervical vertebra in adults or the fourth cervical vertebra in infants. The trachea extends inferiorly to the level of the carina. The inferior end of the trachea is located at the level of the fifth thoracic vertebra or the sternal angle. The ...

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