Foreign Body In Aerodigestive Tract - Standard Treatment Guidelines

Foreign body aspirated into air passage can lodge in the larynx, trachea or bronchi. Children below 4 years are more often affected. Non irritating foreign bodies like plastic, glass or metalls may remain symptomless for a long time. Irritating foreign bodies(vegetative) like peanuts, beans, seeds, etc gives a diffuse violent reaction leading to congestion and oedema of tracheobronchial mucosa-vegetal bronchitis.

Ministry of Health and Family Welfare, Government of India has issued the Standard Treatment Guidelines for Foreign Body In Aerodigestive Tract. Following are the major recommendations:

Symptoms:

Choking, gaging, wheezing: lasts for short time. Foreign body can be cuffed out or it may lodge in larynx or tracheobronchial tree.

Symptomless interval

Later symptoms depends on site of its lodgement:

→Laryngeal: Large foreign body complete can lead to sudden death

Partial: pain, harseness, croupy cough,aphonia, dyspnoea, wheezing and hemopptysis.

→Traheal: loose- palpatory thud, audible slap

→Bronchial:Right>left. Can lead to atelectasis or check valve

Diagnosis:

X-ray

Fluoroscopy

CT scan

Bronchograms

D/D:

Acute laryngotraheo bronchitis

Acute Simple laryngitis

Laryngismus Striduluz

Management:

Antibiotics

Steroids

Laryngeal Foreign Body:

In complete obstruction Pound on back, turn patient upside down, follow Heimlichs Manoeuvre(stand behind the person¸and place your arms around his lower chest and give four abdominal thrusts)

If this fails: Cricothyrotomy or emergency tracheostomy

Once acute respiratory emergency is over: Direct laryngoscopy/ laryngofissure

Tracheal/Bronchial Foreign bodies:

→Conventional rigid Bronchoscope

→Rigid Bronchoscope with telescopic aid

→Bronchoscopy with C arm fluroscopy

→Dormia Basket/ Fogarthy Balloon

→Thoracotomy and bronchotomy for peripheral foregn bodies

→Flexible Fibre optic bronchosopy

Guidelines by The Ministry of Health and Family Welfare :

Dr J M Hans Ex-HOD Dept. of Otorhinolaryngology Dr.RML Hospital New Delhi