Foreign bodies in aerodigestive tract s a common practical question for MBBS/MS ENT students as well as the practitioners. We come across many types of foreign bodies in ENT practice starting from bones, coins, metals etc. One should be competent enough to remove these foreign bodies as well.

1. Foreign Bodies of
Aero-Digestive Tract
Dr. Krishna Koirala
MBBS, MS ( ENT-HNS)
Associate Professor
MCOMS, Pokhara
2016-05-24

2. Introduction
• Foreign Body in Aero-digestive tract is a
common clinical occurrence
• It is an ENT Emergency
• Foreign Body enters the body by either
–Ingestion: “F.B. Esophagus”
–Aspiration: “F.B. Bronchus”

3. Foreign Body ingestion
• Epidemiology
– Children >>> Adults
– Boys > Girls
– No Racial / Geographical Predisposition

4. Etiology
• More common in children
– Lack Molar teeth, poor mastication
– Natural tendency to put objects in mouth
– Play with objects inside mouth
– Easy Distractibility
• Types of F.B
– Coins: Commonest in children
– Household items, Pen cap, Small Toys
– Meat Bone: Commonest in Adults

5. Pathogenesis
• Foreign Body lodges in esophagus at
–Just below Crico-pharynx ; Commonest ; ??
–Above Crico-pharynx
–Above Aortic constriction
–Above Left Bronchial constriction
–Above Gastro-esophageal junction

6. Symptoms
• Odynophagia /Dysphagia
• Drooling of Saliva
• Refusal to take oral feeds
• Fever + Prostration
• Difficulty breathing
• Chest / Back Pain
• Collapsing Child
• Hematemesis

7. Signs
• Usually no clinically elicitable signs
• Drooling saliva
• Fever
• Tachypnea
• Tachycardia
• Hamman’s Sign
– Seen in esophageal Perforation with pneumomediastinum
– Quashing sound over precordium with each heartbeat

8. Investigations
• X-ray Neck and Chest
– Always get both AP and Lateral views
– Radio-opaque foreign body easily seen
– Radio-lucent F.B. evidenced by Air in the Esophagus
• Barium Swallow
– Radio-lucent F.B well visualized
• Esophagoscopy
– Diagnostic as well as Therapeutic

9. Radio - Opaque F.B Esophagus

10. Double Lumen Sign: Disc Battery

11. Radio-Lucent F.B Esophagus

12. Treatment
• Observation
• Balloon Catheter Removal
• Rigid Esophagoscopy and removal with forceps
• Thoracotomy

13. 1. Observation
– Usually for 24 hours
•Immediate presentation
•Blunt foreign body below the cricopharynx
•Child Stable
– Spontaneous passage of foreign body into the stomach is
expected
– If it doesn’t pass into stomach, Esophagoscopy is done
– C/I: Disc Battery Ingestion: emergency (Risk of liquifactive /
coagulation necrosis)

14. 2. Balloon Catheter Removal
–Performed in centers where there is no
access to esophagoscopy
–90 % efficacy
–Advantages: No GA, Cost effective
–Complications: Emesis, Tracheal placement
–Esophagoscopy needed in case of failure

15. 3. Rigid Esophagoscopy and foreign body
removal with forceps
– Gold Standard Modality
– GA Needed
– Complications
•Iatrogenic Perforation, Oro-dental injury
4. Thoracotomy
– Migrated F.B, unsuccessful rigid esophagoscopy

16. • Epidemiology
– More common in children than adults
– Boys > girls
– No racial / geographical predisposition
Foreign Body Aspiration

17. Etiology
• Commonly seen in children
– Poor airway reflexes
– Lack Molar teeth ,poor mastication
– Natural tendency to put objects in mouth
– Play with objects inside mouth
– Easy distractability
• Type of F.B
– Vegetable Matter: Peanuts Commonest
– Pen cap, whistles, safety Pin

18. Pathogenesis
• Foreign Body lodges in
– Bronchi
•Right Main Bronchus Commonest
•Sitting / Standing Position
–Rt. Lower Lobe- Lower portion
•Supine Position
–Rt. Lower Lobe- Upper portion
– Trachea
– Larynx

19. Right main Bronchus- Straighter and Wider

20. Symptoms
• Choking
• Gagging
• Violent Coughing
• Dyspnea
• Stridor
• Wheezing
• Cyanosis
• Hoarseness

21. Signs
• Inspiratory Stridor
• Bi-phasic Stridor
• Expiratory Stridor
• Unilateral Wheezing
• Decreased Breath Sounds

22. Investigations
• X-ray Neck and Chest
– PA and Lateral Views
– Inspiratory and expiratory films – air trapping
– Atelectasis
– Pneumonitis
– Consolidation
• Airway Fluoroscopy
– Radio-lucent F.B
• Bronchoscopy
– Diagnostic as well as therapeutic

23. Radio - Opaque F.B Rt. Main Bronchus

24. Radio-Lucent F.B. Rt. Lung ( Hyperinflation)

25. Radio-Lucent F.B Lt. Bronchus (Atelectasis)

26. Radiolucent F.B seen on Fluoroscopy

27. Treatment
• Rigid Bronchoscopy and foreign body removal
– Gold Standard
• Fiber-optic Bronchoscopy
– F.B in distal bronchus
• Tracheostomy & F.B Removal
– Large F.B in Sub-glottis
• Thoracotomy: Migrated F.B

28. F.B . Trachea

29. Bronchoscopes

30. Optical forceps
Net F.B retrieval system

31. First aid ‘choking’
• Back blows
• Abdominal thrusts /Heimlich maneuver
• Chest thrusts

32. Back Blows
Five rapid blows given by heel of hand between
shoulder blades

33. Abdominal thrusts
5 rapid thrusts given between umbillicus and xiphisternum

34. Chest thrusts
5 rapid thrusts given in middle of sternum

35. Errors to avoid in suspected foreign
body cases
• Do not reach for the foreign body with the
fingers
• Do not blindly pass an esophageal bougie or
other instruments
• Do not hold up the patient by the heels

36. • Do not fail to have an X-ray done

37. • Do not fail to search endoscopically for a
foreign body in all cases of doubt

38. • Do not tell the patient he has no foreign body
until after X-Ray examination, physical
examination, indirect examination and
endoscopy all have proven negative