The presence of an airway foreign body is a common cause of morbidity and mortality in children, especially those younger than 3 years of age. Over 70% of foreign body aspirations occur in children.1 The mortality rate following foreign body aspiration is estimated at 1% to 2%. In the year 2000, ingestion or aspiration of a foreign body was the cause of 160 unintentional deaths and more than 17,000 Emergency Department visits in the United States.2 Other reports have estimated the death toll as high as 2000 per year in the United States.1 The most likely cause of death is complete airway obstruction, generally at the level of the larynx or trachea. Food objects have been associated with 41% and nonfood substances have been associated with 59% of reported deaths.2 Globular objects such as hot dogs, candies, chewing gum, nuts, and grapes are the most commonly aspirated food objects.3 Rubber balloons and toys are the most commonly aspirated nonfood objects.3
Parents and caregivers should be educated and aware of the types of food and objects that pose a choking risk for children. They should become familiar with the methods to reduce this risk. All parents and caregivers should learn the techniques to treat a choking child. Basic life support classes are often available free or at a minimal cost at hospitals, churches, and community centers.
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 the potential complications related to airway obstruction. Cases involving children require specialized expertise in pediatric airway endoscopy. Prior to the twentieth century, aspiration of a foreign body resulted in a 24% mortality rate. 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 Emergency Physician's hands in order to diagnose an airway foreign body. Keep in mind that information gained from the history, physical examination, and radiologic studies may not clearly define the presence of a foreign body.4 Thirty-three percent of airway foreign body cases are neither observed nor suspected. The physical examination may be normal in up to 39% of patients. Radiographic studies may be normal in up to 20% 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 ...