When Things Go Wrong: Laryngeal and Tracheal Foreign Bodies

Introduction

The larynx and trachea are vital components of the respiratory system and have vital roles in breathing, vocalization, as well as protecting the airway. The larynx has vocal cords and helps humans with speech. Below the larynx is the windpipe, the trachea, which carries air to and from the lungs. Both these structures enable the passage of air while preventing foreign objects from entering the lungs. However, accidentally, sometimes, foreign bodies can enter the larynx or trachea and lead to potential complications that may require immediate medical help.

What Does Laryngeal and Tracheal Foreign Body Mean?

A foreign body or foreign objects, especially among young children, commonly involves items such as food, toys, live bees, coins, or other similarly small objects. Accidentally swallowing these can cause significant risk as these objects are capable of obstructing the small air passage, leading to breathing difficulties and subsequently may cause serious health complications such as hypoxic-ischemic brain injury due to limited or no oxygen supply to the brain. It is also one of the primary causes of death following foreign body ingestion. Foreign bodies can enter the larynx and trachea through various means, including:

• Inhalation of objects can occur during activities such as eating, drinking, playing with small toys, or inhaling airborne particles.

• Ingestion of objects can happen when objects are swallowed without proper chewing or during episodes of coughing or vomiting.

• In some cases, foreign bodies can enter the airway due to traumatic injuries such as falling face down, and objects or fragments may be forced into the larynx or trachea.

What Are the Symptoms of Foreign Bodies in the Larynx or Trachea?

The symptoms involved with foreign bodies present within the larynx or trachea vary. This depends on the type and size of the foreign body and the mode through which the foreign body reaches the trachea or larynx, and the location where the object is lodged. Some of the common symptoms include:

• A sense of feeling choked or feeling gagged in the throat.

• Persistent or recurrent cough that may also see specks of blood while coughing (hemoptysis)

• Difficulty breathing, shortness of breath, or labored breathing.

• Wheezing.

• Noisy breathing (stridor) indicates airway obstruction.

• Changes in the voice, such as hoarseness or voice loss.

• Drooling.

• Discomfort in the throat region or chest.

• Bluish discoloration of the skin or lips due to inadequate oxygen.

• If failed to seek medical attention at the earliest, the complication could lead to sudden death.

How to Diagnose the Presence of Foreign Body in the Larynx or Trachea?

Suspicion of a foreign object in the larynx or trachea is present from the moment the individual or someone says to have witnessed the inhalation or ingestion of the foreign object. The common procedures involved in diagnosing foreign bodies in the larynx or trachea include:

• Physical Examination - The doctor conducts a physical assessment of the neck and throat for any visible signs of airway obstruction. The chest is examined to check for abnormal breathing sounds. The doctor may also enquire about any known possibility of a foreign body being inhaled or ingested.

• Bronchoscopy - This procedure involves inserting a flexible or rigid specialized tube into the airway to visualize and detect the presence of any foreign object in the larynx or trachea. A rigid bronchoscope is preferred over the flexible bronchoscope as a rigid bronchoscope.

• X- Rays - Chest X-ray or lateral chest X-ray can be done to detect the presence of radiopaque objects in the larynx or trachea.

• Computed tomography (CT) Scan - In cases where the foreign object is not detected on X-rays or physical examination, the doctor may request a CT scan to get a detailed cross-sectional view of the airway, which can help identify the location and the characteristics of lodged foreign objects.

How to Manage a Foreign Body in the Larynx or Trachea?

The specific management approach may vary depending on the severity of symptoms, the type, the size, the location of the foreign body, and the individual's condition. However, it involves intervening at the earliest to remove the object and ensure the individual's airway is clear. Some general management strategies include:

• Immediate Intervention - If one finds an individual choking or gagging due to the presence of a foreign body in the larynx or trachea, the American Red Cross recommends certain guidelines to help the individual. The guidelines include the following:

• Give Five Blows at the Back – Stand right behind and to the side of the choking individual. One must kneel down if the choking individual is a child. Arms need to be placed across the chest of the individual to support their body. Then bend over the individual at the waist in such a way that the individual faces the ground. With the heel of the hand, strike between the shoulder blades of the individual five times.

• Give Five Thrusts to the Abdomen- If back blows do not remove the stuck object, give five abdominal thrusts, also known as the Heimlich maneuver. To perform the Heimlich maneuver, one needs to stand behind the choking individual and wrap arms around their waist. Make a fist and place it above their navel. Grasp the fist with the other hand and give quick, upward thrusts into the abdomen. Repeat up to five times until the obstruction is dislodged.

• Repeat the Sequence - Continue alternating between five blows to the back and five abdominal thrusts until the blockage is successfully cleared.

• Bronchoscopy - This method allows the insertion of a thin, flexible tube (bronchoscope) or a rigid tube (rigid bronchoscope) into the airway to visualize and precise removal of the foreign object under direct vision.

• Surgery - In complex cases or when the foreign body cannot be easily accessed or removed through bronchoscopy, surgery may be required. This could involve a tracheotomy (creating an opening in the trachea) or a more extensive procedure to remove the foreign body.

Complications become more likely as the duration between inhalation and removal of the foreign body increases.

What Are the Complications Associated With the Laryngeal and Tracheal Foreign Body?

Various complications can arise if the foreign object remains in the larynx or trachea for a prolonged period. Some of the complications include:

• Recurrent Pneumonia.

• Bronchiectasis - Permanent dilation or damage to the bronchial tubes.

• Lung Abscess - Collection of pus in the lung tissue.

• Atelectasis - Partial or complete collapse of the lungs.

• Bronchial Stenosis - Narrowing of the bronchial tubules.

• Tracheal Lacerations - Injury or tear involving the trachea.

• Obstructive Emphysema - A lung condition that causes breathing difficulty.

Conclusion

Prompt recognition and appropriate diagnostic measures are important in managing foreign bodies in laryngeal and tracheal spaces to minimize potential adverse effects. After the successful removal of the foreign body, providing supportive care and monitoring of the individual is important as well. A post-removal chest X-ray is recommended to confirm airway clearance and identify the presence of any complications. These measures can help contribute to the optimal recovery of the individual.