The peak incidence of foreign body aspiration is in the 1- to 3-year age group. At least 90 percent of cases are seen in children under age 4, but it has been reported in infants as young as 3 months. In children younger than 6 months, foreign-body aspiration is often secondary to a feeding given by "a helpful sibling."
The most commonly aspirated foreign bodies fall into two groups: foods and toys.26 The most dangerous objects are those that are cylindrical or small, smooth, and round. Commonly aspirated foods include peanuts, sunflower seeds, raisins, grapes, hot dogs, and smaller sausages.
Because of the large number of deaths due to the aspiration of toys, the federal government instituted the Consumer Product Safety Act of 1979, 27 which has decreased the incidence of toy aspiration. However, watch groups warn that most toys are not properly evaluated for safety prior to marketing. Consumer scrutiny by direct inspection of the toy in addition to reading any warning label and the appropriate age range printed on its carton should be stressed in providing anticipatory guidance to the parents of young children.
Although small, round metal objects typically do not cause tissue reactions, this is not the case with vegetable matter. Aspirated vegetable matter commonly causes an intense pneumonitis and subsequent pneumonia and/or suppurative bronchitis. Aspirated vegetable matter is commonly difficult to remove if not found early, as it swells with the absorption of moisture from the surrounding lung and, if left long enough, may even sprout.
At presentation, many patients with foreign-body aspiration may be completely asymptomatic with a normal physical exam. Some data suggest that the majority will present or have presented previously with symptoms consistent with but not specific for foreign body aspiration. The study of Laks and Barzilay demonstrated fever in 36 percent, wheeze in 35 percent, crackles in 38 percent, and tachypnea in 45 percent of patients at presentation. 29 Although the location of the aspirated foreign body does play a role in determining the symptoms and signs seen on presentation, there is overlap between groups. Classic dogma is that laryngotracheal foreign bodies cause stridor, whereas bronchial foreign bodies cause wheeze. Studies have shown, however, that about 30 percent of laryngotracheal foreign bodies and up to 10 percent of bronchial foreign bodies will demonstrate wheezing and stridor respectively. More importantly, a significant proportion will have no cough, wheeze, or stridor. It is true that the majority of patients presenting with severe immediate onset stridor or cardiac arrest after aspiration will be found to have a laryngotracheal foreign body. Patients with alternating wheezing and stridor may have a mobile foreign body. Other signs and symptoms of foreign-body aspiration may include cough, history of a choking episode, history of persistent or recurrent pneumonia, apnea, pharyngeal pain, or persistent symptoms of croup or asthma remaining after adequate treatment for 5 to 7 days. Foreign-body aspiration should be considered in all children given a diagnosis of "unilateral wheeze." Upper esophageal foreign bodies may impinge upon the posterior aspect of the trachea, leading to signs and symptoms of airway obstruction. Commonly the patient will present with stridor. Contrary to most cases of airway aspiration, patients with an esophageal foreign body typically will have dysphagia.
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