Foreign bodies in the aerodigestive tract can be life threatening if not detected early. It is estimated that approximately 1500 people die annually from complications related to foreign-body ingestion and aspiration, with children being the commonest victims.32 Although a history of solid-particle ingestion is important, this information is often missing for children. The most common foreign body ingested by children is a coin, the second most common is food (e.g., peanuts and popcorn).33 Because many of the symptoms may be subtle in children, a high index of suspicion is required to arrive at the correct diagnosis before several days have passed. In all children with choking, stridor, wheezing, or unexplained cough, foreign-body aspiration should be suspected. The symptoms in adults are more obvious because adults recognize the symptoms and seek help early. The most common foreign bodies in adults are fishbones, dentures, meat, and meat bones ( Fig
Symptoms of laryngeal or tracheal foreign-body aspiration classically follow sudden onset of choking or coughing. Symptoms are listed in Table- 235-5. The stridor resembles croup, with a high-pitched inspiratory quality usually associated with a barking cough. Wheezing may be heard throughout the lung fields but is usually loudest over the involved area.35 Chronic cough or wheezing that fails to respond to medical management, especially in a child without a history of previous reactive airway disease, should raise suspicions of an airway foreign body. In contrast to patients with foreign-body aspiration, patients with foreign-body ingestion usually complain of dysphagia, chest pain, or nausea, which may be accompanied by drooling and vomiting. Cough is uncommon, since most symptoms are related to the pharynx, esophagus, and stomach.
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