Foreign body in the larynx refers to the presence of foreign objects in the supraglottic region, glottic region, or subglottic region. This condition occurs most commonly in children under the age of five and is a frequent pediatric emergency. The glottic slit is the narrowest part of the respiratory tract, and foreign bodies lodged in this area can easily lead to respiratory distress. If timely medical intervention is not provided, the risk of asphyxiation and death is significant.
Etiology
Foreign body aspiration is often caused by holding objects in the mouth or eating while suddenly speaking loudly, laughing, or crying.
The types of foreign bodies are diverse and include:
- Sharp foreign bodies, such as fruit pits, bone fragments, fish bones, melon seeds, needles, and nails.
- Larger foreign bodies, such as jelly, peanuts, and broad beans.
- Objects placed in the mouth by children during play, such as coins, beads, and small toys.
Clinical Manifestations
Foreign bodies entering the laryngeal cavity immediately cause severe choking and coughing. Reflexive laryngeal spasm and obstruction by the foreign body can result in respiratory distress and cyanosis. Larger foreign bodies lodged in the glottic or subglottic regions may lead to death from asphyxiation within minutes. Partial obstruction of the laryngeal cavity may result in symptoms such as severe coughing, varying degrees of respiratory difficulty, stridor, hoarseness, and throat pain.
Examination
Laryngoscopic examination may reveal the presence of a foreign body in the larynx. Subglottic foreign bodies are often oriented in an anteroposterior position, in contrast to esophageal foreign bodies, which are typically oriented in a coronal position.
Diagnosis
The diagnosis can be confirmed based on a history of foreign body aspiration, clinical symptoms, findings from laryngoscopy, and imaging studies such as lateral and anteroposterior X-rays or CT scans of the larynx.
Treatment
The foreign body needs to be removed promptly using direct laryngoscopy. Equipment such as bronchoscopes, tracheal foreign body forceps, and suction devices should be available to manage cases where the foreign body may dislodge into the trachea during surgery.
When respiratory distress is severe and removal via direct laryngoscopy is estimated to be difficult, an emergency tracheotomy may be required. After alleviating respiratory distress, the foreign body can then be removed using direct laryngoscopy or retrieved upward through the tracheostomy if it is a larger subglottic object.
Prevention
Foreign bodies in the larynx pose a significant hazard, and awareness and preventive measures are essential. Small objects should not be placed in areas accessible to children. During meals, children should not be teased, reprimanded, or allowed to eat while laughing or crying loudly. Children should not play with needles, nails, small toys, or similar objects in their mouths. Whole peanuts, beans, or other similar foods should be avoided, and children’s meals should be free of fish bones, bone fragments, or other materials that might lead to accidental inhalation of a foreign body into the respiratory tract.