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Foreign Body in the Larynx

Foreign Body of Larynx


Presentation

  • We report a case of delayed and unusual presentation of impacted laryngeal foreign body in a 35 year old man presenting with unremitting hoarseness for 3 months.[casereports.in]
  • We present a rare case of foreign body of larynx which was managed successfully.[jemds.com]
  • Two adult patients of foreign body larynx who presented to us with a short history of foreign body inhalation with severe respiratory distress are being reported.[ncbi.nlm.nih.gov]
  • In this article, we report a patient with unusual laryngeal foreign body lodgement: a bee which presented with sudden odynophagia and stinging sensation in throat.[ncbi.nlm.nih.gov]
  • Laryngeal foreign bodies may present with less severe symptoms compared with lower respiratory tract foreign bodies, resulting in misdiagnosis, confusion and delay in diagnosis.[ncbi.nlm.nih.gov]
Cough
  • In most cases of inhaled foreign body, there is a definite history of choking followed by paroxysmal coughing. After the initial paroxysm of coughing the tracheobronchial mucosa becomes tolerant of the foreign body and coughing ceases.[jiom.com.np]
  • Introduction Laryngeal impaction of foreign bodies are very rare as most aspirated foreign bodies passes through the laryngeal inlet and get lodged lower down in the airway or is coughed out by cough reflex.[casereports.in]
  • When a FB tries to enter the larynx through glottis, spasm and severe cough expels it to supra glottis and if cough is forceful FB expels out of larynx and if cough is weak because of alcohol intoxication it may be held up in the vestibule of the larynx[jemds.com]
  • If coughing is forceful, it may be expelled out of the larynx.[waent.org]
  • He presented with a history of intractable cough that did not respond to any treatment. On flexible fiberoptic laryngoscopy, he had a bluish string originating in the trachea and emerging between the vocal cords.[ghorayeb.com]
Stridor
  • The foreign bodies accidentally entering the larynx are symptomatic in the form of choking, stridor or even death. We are presenting a rare case of foreign body in the larynx in a 42 year old male who was symptom free except for dysphonia.[jemds.com]
  • Resumed Report: An 11-month-old female patient (M.F.S.) presented to a tertiary hospital with severe dyspnea and stridor.[thieme-connect.com]
  • No history of stridor, difficulty with breathing or dysphagia, psychiatric tendency or family history of psychiatric disorders was elicited. He neither smoke nor drank alcohol. He was taking orally well and slept fairly well.[casereports.in]
  • They presented with severe attacks of inspiratory stridor, difficulty in breathing and spitting blood. Indirect laryngoscopy revealed a dark greenish living foreign body in the larynx in each case.[ncbi.nlm.nih.gov]
  • On 6/5/95 he developed severe stridor and visited the T.U. Teaching Hospital. He had the impression that he had cancer larynx so he did not give the history of denture ingestion.[jiom.com.np]
Hoarseness
  • This 47-year-old female noted hoarseness that started 5-7 years before I saw her. The hoarseness has become progressively worse over the past 2 years. During the past 2 years, she has noted breaks in her voice and an increased effort to make sound.[voicedoctor.net]
  • We report a case of delayed and unusual presentation of impacted laryngeal foreign body in a 35 year old man presenting with unremitting hoarseness for 3 months.[casereports.in]
  • Teaching Hospital with a complaint of breathing difficulty and hoarseness for one month on 8/9/95. Emergency tracheostomy and direct laryngoscopy and biopsy were done.[jiom.com.np]
  • Case Report: An 18 year old girl from the countryside presented with hoarseness of 3 hours duration. When she went to the fields to collect fodder for cattle she accidently inhaled some object during inspiration.[waent.org]
  • In one case reported by Wither, American coin (Dime) was retrieved from vestibule of larynx which presented as hoarseness.[jemds.com]
Dyspnea
  • Diop et al. [2] were found in 83.07% of cases dyspnea and dysphonia in the remaining cases. The case dysphonia without dyspnea can be explained by the presence of a foreign body windowed allowing the ventilation airways.[scirp.org]
  • Resumed Report: An 11-month-old female patient (M.F.S.) presented to a tertiary hospital with severe dyspnea and stridor.[thieme-connect.com]
  • Objects that are only partially obstructing and thus compatible with life may cause hoarseness, croupy cough, aphonia, odynophasia, haemoptysis, wheezing and varying degrees of dyspnea.[jiom.com.np]
  • Children may otherwise present with cough, dyspnea, or irritability 2,6. Most (70-90%) foreign bodies are organic, most commonly seeds and nuts. Inorganic foreign bodies vary dramatically and can include teeth, coins, pins, pens/crayons, etc.[radiopaedia.org]
  • Large pharyngeal foreign body peracute respiratory dyspnea and acute dysphagia. A life-threatening respiratory obstruction may occur if a large foreign body becomes firmly lodged.[vetstream.com]
Inspiratory Stridor
  • They presented with severe attacks of inspiratory stridor, difficulty in breathing and spitting blood. Indirect laryngoscopy revealed a dark greenish living foreign body in the larynx in each case.[ncbi.nlm.nih.gov]
  • Ask the patient to cough ; aspirated foreign objects can often be ejected in this manner, especially if they have not passed the level of the glottis (Zitzmann et al. 2000) If coughing leads to choking, respiratory difficulties or inspiratory stridor,[med-college.hu]
Choking
  • The patient was nearly choked to death but resuscitated successfully without any sequelae.[jstage.jst.go.jp]
  • Ruben H, Macnaughton FI (1978) The treatment of food-choking. Practitioner 221:725–729 PubMed Google Scholar 22.[link.springer.com]
  • The foreign bodies accidentally entering the larynx are symptomatic in the form of choking, stridor or even death. We are presenting a rare case of foreign body in the larynx in a 42 year old male who was symptom free except for dysphonia.[jemds.com]
  • In most cases of inhaled foreign body, there is a definite history of choking followed by paroxysmal coughing. After the initial paroxysm of coughing the tracheobronchial mucosa becomes tolerant of the foreign body and coughing ceases.[jiom.com.np]
  • A choking episode followed by an audible wheeze (55%) was the most common presenting complaint. Obstructive emphysema was demonstrated in 60% and was best demonstrated by inspiration-expiration chest roentgenograms or fluoroscopy.[ncbi.nlm.nih.gov]
Cyanosis
  • There was no cyanosis or intercostal retractions. Indirect endoscopic examination revealed an irregular object on the right vocal cord with thick secretions (Fig. 1). Soft tissue lateral x-ray was obtained which was inconclusive.[waent.org]
  • Typical anamnesis in the case of aspiration of a foreign body into the lower respiratory tract is a paroxysmal cough connected with cyanosis of the patient.[czytelniamedyczna.pl]
  • If blockage is complete, then can have cyanosis and severe distress / arrest. Trachea – similar to larynx in presentation, but can have biphasic stridor, dry cough. Often appear uncomfortable or scared.[pedemmorsels.com]
  • Acute symptoms Frequent touching of the throat by the distressed patient Facial paleness followed by cyanosis Coughing Choking, vomiting Early complications Acute respiratory distress (dyspnea) Respiratory depression or arrest due to airway obstruction[med-college.hu]
  • May see choking, gagging, coughing, and/or cyanosis. High risk of death. Second phase: Quiescent asymptomatic period. May last minutes to months depending on location, type, and ease of movement of the foreign body.[hawaii.edu]
Dysphasia
  • On examination the attending doctor could not find the denture and referred him to India for the treatment of cancer larynx, the patient was having pain in the throat, mild dysphasia and occasional breathing difficulty all these years.[jiom.com.np]

Workup

  • The initial workup is the same as with any foreign body sensation in the throat.[ncemi.org]

Treatment

  • From our experience, the followings should be emphasized for successful treatment of life-threatening foreign bodies in the larynx: (1) Immediate resuscitating procedures should be taken if the diagnosis of foreign body in the larynx is established. ([jstage.jst.go.jp]
  • Ruben H, Macnaughton FI (1978) The treatment of food-choking. Practitioner 221:725–729 PubMed Google Scholar 22.[link.springer.com]
  • He presented with a history of intractable cough that did not respond to any treatment. On flexible fiberoptic laryngoscopy, he had a bluish string originating in the trachea and emerging between the vocal cords.[ghorayeb.com]
  • The treatment is based on endoscopy under general anesthesia to remove the foreign body. So overall there are few problems for the diagnosis of foreign body larynx, the treatment involves a series of difficulties already mentioned in part.[scirp.org]
  • On examination the attending doctor could not find the denture and referred him to India for the treatment of cancer larynx, the patient was having pain in the throat, mild dysphasia and occasional breathing difficulty all these years.[jiom.com.np]

Prognosis

  • Despite the delay in diagnosis, the conduct of the expert was essential for the patient's prognosis.[thieme-connect.com]
  • The prognosis remains however encumbered with a mortality and a morbidity not insignificant. In underdeveloped countries like ours, the difficulties in the management of this affection are numerous.[scirp.org]
  • Treatment and prognosis Bronchoscopy is considered the gold standard in the diagnosis of tracheobronchial tree foreign bodies 3, with the added benefit of being able to potentially retrieve the foreign body.[radiopaedia.org]
  • […] endoscopically Once they pass into stomach, such batteries pose a lower risk Complications Always check for lead lines in children (pica) Longer the FB remains impacted ( 24hrs), higher incidence of perforation Perforation Stricture Diverticulum formation Prognosis[learningradiology.com]
  • Prognosis : generally good. Pathogenesis Etiology Foreign body is accidentally inhaled and becomes lodged in either the nasal passages or the pharynx depending on size.[vetstream.com]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Pathogenesis Etiology Foreign body is accidentally inhaled and becomes lodged in either the nasal passages or the pharynx depending on size. Predisposing factors General Wood chewing, eg crib-biter Behavior: crib-biting and wind-sucking.[vetstream.com]
  • Mortality Another report by Cheng and colleagues determined that between 2000 and 2009, US pediatric inpatients with airway foreign bodies had a weighted mortality rate of approximately 2.75%, with the rate staying relatively unchanged over that period. [4] Etiology[emedicine.medscape.com]

Epidemiology

  • The aim of this study was to identify epidemiological, clinical and therapeutic features that characterize the foreign bodies of the larynx in our context in order to make the inventory of fixtures. 2.[scirp.org]
  • Epidemiology Aspiration of foreign bodies by children can lead to serious illness and sometimes even death.[pedsinreview.aappublications.org]
  • Epidemiology Frequency Most airway foreign body aspirations occur in children younger than 15 years; children aged 1-3 years are the most susceptible.[emedicine.medscape.com]
  • Epidemiology Ages affected (typical range 1 to 4 years old) Age under 3 years old: 50% Age under 4 years old: 80% Age under 10 years old: 95% Increased Incidence at holiday time Known object aspiration in less than 40% of cases Choking deaths related[fpnotebook.com]
  • Epidemiology The ingestion of foreign bodies is most commonly a problem in young children aged 6 months to 5 years.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology The physical presence of the foreign body causes an obstruction and irritation. Timecourse Large foreign bodies will cause acute onset clinical signs. Smaller foreign bodies may result in more chronic duration of clinical signs.[vetstream.com]
  • Pathophysiology After foreign body aspiration occurs, the foreign body can settle into 3 anatomic sites, the larynx, trachea, or bronchus. Of aspirated foreign bodies, 80-90% become lodged in the bronchi.[emedicine.medscape.com]

Prevention

  • A small proportion of foreign bodies become impacted in the larynx, when urgent recognition is required to prevent disaster.[ncbi.nlm.nih.gov]
  • This mechanism prevents food from entering the trachea. 3 The larynx and the cough reflex is an important defense mechanism which prevents entry of a foreign body into respiratory tract.[waent.org]
  • It is important that the medical fraternity is aware of the presence of foreign body airway, since early diagnosis and intervention prevent a potentially fatal outcome.[thieme-connect.com]
  • Heimlich HJ, Hoffman KA, Canestri FR (1975) Food-choking and drowning deaths prevented by external subdiaphragmatic compression-Physiological basis. Ann Thorac Surg 20:188–195 PubMed CrossRef Google Scholar 23.[link.springer.com]
  • In some cases FB in larynx can be removed under local anesthesia to prevent slippage of FB particularly smooth FB like coin in one case, an alpin impaction resulting from casual fiddling in the other. [2] Egg shells, glass fragments, plastic are sometimes[jemds.com]

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