Airway foreign bodies: a diagnostic challenge

Foreign bodies can become lodged anywhere in the air passages, depending on their size, shape, and makeup. Symptoms of laryngeal foreign body inhalation can vary greatly but usually include one or more of the following: hoarseness, croupy cough, stridor, wheezing, dyspnea, cyanosis, hemoptysis, aphonia, odynophagia, or a subjective feeling of the presence of a foreign substance. Foreign body inhalation occurs most often in children and the elderly. The symptoms of bronchial foreign body inhalation are very similar to those of laryngeal foreign body inhalation. Usually, after the initial expression of acute symptoms, a period of quiescence follows during which little or no evidence of a problem is manifest. It is during this period of subtle symptoms that treatment is often mistakenly directed toward an infectious cause. The authors describe two unusual cases, one of laryngeal and one of bronchial foreign body ingestion. They also discuss their diagnosis and management.