The two-headed stethoscope: its use for ruling out airway foreign bodies

Foreign body aspiration is a common concern for physicians and surgeons who care for children. Evaluating infants and toddlers to rule out this possible diagnosis is often fraught with difficulties. Specifically, the standard stethoscope is of limited use unless unilateral asymmetry of breath sounds can be appreciated. Inspiratory and expiratory chest X-rays in children often appear to show a very similar diaphragmatic excursion and, unless the object is radiodense, the determination of foreign body aspiration is frequently not possible. Other procedures, such as flexible or rigid endoscopy, are more invasive and are reserved for children with positive findings or a less acute but more perplexing scenario. We present the use of the two-headed stethoscope as an option for evaluation of children to rule out foreign body aspiration. Our experience with this instrument over the past 10 years has consistently allowed us to non-invasively differentiate the presence or absence of objects in the airway.