Excerpt from Foreign Bodies, Trachea

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Foreign body aspiration can result in a spectrum of presentations, from minimal symptoms, often unobserved, to respiratory compromise, failure, and even death.

This article is not intended to cover in detail acute airway obstruction from foreign body aspiration; for these patients, emergency life-saving interventions are needed.

The epidemiology of tracheobronchial foreign bodies is bimodal, with peaks at the extremes of age.

Children aged 1-3 years are particularly at risk because of their increasing independence, lessening of close parental supervision as they become older, and increasing activity and curiosity and because of hand-mouth interactions. Often, foods such as grapes and pieces of hot dogs that are easily handled by older children can be aspirated and occlude the airway. Smaller objects, such as peanuts, are easily aspirated into the bronchi by children.

Elderly patients, particularly those with primary neurologic disorders and decreased gag reflexes due to alcohol, seizures, strokes, parkinsonism, trauma, and senile dementia are also at risk of aspiration; any number of objects, food, and stomach contents can be aspirated.

A third category of at-risk individuals is those undergoing procedures with sedation, particularly dental procedures or emergency intubation.

The diagnosis is often missed initially, especially in children where the history may be vague and the patient cannot verbalize the events. In as many as 30% of patients, symptoms are treated as those of other common diseases, especially in patients with minimal symptoms. A high index of suspicion is required to make the diagnosis, especially in children and patients who are debilitated.

For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center and Procedures Center . Also, see eMedicine's patient education articles, Choking, Swallowed Object, and Bronchoscopy.

Pathophysiology

Aspirated foreign bodies most commonly are lodged in the right main stem and lower lobe. Aspiration has been documented in all lobes including the upper lobes, though with less frequency.

In the US, peanuts are by far the most commonly aspirated material in children, followed by organic material such as sunflower seeds, pieces of vegetables, and hazelnuts. In other countries, the most common aspirated material remains food items, but the type of food differs from culture to culture.

In adults, vegetable matter, meat, and bones rank highest, followed by dental and medical appliances. Aspiration of teeth after trauma is occasionally observed.

Mortality

Annual death rates from aspiration of foreign bodies range from 350-2000 in the US. Most are children, particularly aged 1-3 years. The most common etiology of aspiration deaths in children is a toy, with balloons accounting for 29% of deaths. Foods most responsible for aspiration deaths in the US are hot dogs, candy, nuts, and grapes. The mortality rate of tracheobronchial foreign body aspiration is approximately 1%.

Sex

Male predominance is found in most studies, particularly in children. Approximately 60% of patients in the United States are male, depending on the study. Interestingly, in studies from outside the United States, females often predominate.

Age

Age frequency is bimodal, with individuals aged 1-3 years and those in the seventh decade of life at higher risk of foreign body aspiration

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