Diagnosis Of Foreign Body In The Air Or Food Passages

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The questions arising are:

I. Is a foreign body present?

2. Where is it located?

3. Is a peroral endoscopic procedure indicated?

4. Are there any contraindications to endoscopy?

In order to answer these questions the definite routine given below is

followed unvaryingly in the Bronchoscopic Clinic.

1. History.

2. Complete physical examination, including mirror laryngoscopy.

3. Roentgenologic study.

4. Endoscopy.

The history should note the date of, and should delve into the details

of the accident; special note being made of the occurrence of

laryngeal spasm, wheezing respiration heard by the patient or others

(asthmatoid wheeze), fever, cough, pain, dyspnea, dysphagia,

odynphagia, regurgitation, etc. The amount, character and odor of

sputum are important. Increasing amounts of purulent, foul-odored,

sometimes blood-tinged sputum strongly suggest prolonged bronchial

foreign body sojourn. The mode of onset of the persisting symptoms,

whether immediately following the supposed accident or delayed in

their occurrence, is to be noted. Do attacks of sudden dyspnea and

cyanosis occur? What has been the previous treatment and what attempts

at removal have been made? The nature of the foreign body is to be

determined, and if possible a duplicate thereof obtained.

General physical examination should be complete including inspection

of the eyes, ears, nose, pharynx, and mirror inspection of the

naso-pharynx and larynx. Special attention is paid to the chest for

the localization of the object. In order to discover conditions

rendering endoscopy unusually hazardous, all parts of the body are to

be examined. Aneurysm of the aorta, excessive blood pressure, serious

cardiac and renal conditions, the presence of a hernia and the

existence of central nervous disease, as tabes dorsalis, should be at

least known before attempting any endoscopic procedure. Dysphagia

might result from the pressure of an unknown aneurysm, the symptoms

being attributed to a foreign body, and aortic aneurysm is a definite

contraindication to esophagoscopy unless there be foreign body present

also. There is no absolute contraindication to the endoscopic removal

of a foreign body, though many conditions may render it wise to

post-pone endoscopy. Laryngeal crises of tabes might, because of their

sudden onset, be thought due to foreign body.