‌Symptoms of Airway Foreign Bodies

When a foreign body enters the lower respiratory tract, it typically triggers ‌violent coughing‌ initially, followed by a variable asymptomatic period, which often leads to misdiagnosis. Symptoms vary depending on the nature, location, and shape of the foreign body.

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‌1. Laryngeal Foreign Body‌

• ‌Immediate Reactions‌: Choking, shortness of breath, reflexive laryngeal spasms, and ‌inspiratory stridor‌ (high-pitched breathing sound).
• ‌Severe Cases‌:
  • Hoarseness or difficulty swallowing if lodged near the laryngeal inlet.
  • Complete obstruction at the glottis can cause sudden suffocation and death.

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‌2. Tracheal Foreign Body‌

• ‌Initial Symptoms‌: Similar to laryngeal foreign bodies, dominated by choking and coughing.
• ‌Later Manifestations‌:
  • Mobile objects cause ‌paroxysmal coughing‌ and dyspnea as they move with airflow.
  • A “slapping” sound may be heard at the trachea during exhalation, caused by the foreign body hitting the tracheal wall.
  • Palpable vibrations over the lower thyroid cartilage.
  • Wheezing due to tracheal narrowing from edema or obstruction.

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‌3. Bronchial Foreign Body‌

• ‌Early Symptoms‌: Resemble tracheal foreign body reactions.
• ‌Specific Symptoms by Type‌:
  • ‌Organic Objects‌ (e.g., peanuts, beans): Release irritants (free fatty acids), causing fever, cough, and purulent sputum (acute bronchitis symptoms).
  • ‌Metallic Objects‌: Often asymptomatic for months unless causing blockage.

‌Complications Based on Obstruction Severity‌:

‌A. Partial Bronchial Obstruction‌

• Leads to ‌obstructive emphysema‌:
  • Air enters during inhalation but cannot fully exit during exhalation, trapping air distal to the blockage.
• ‌Clinical Signs‌:
  • Restricted chest movement on the affected side.
  • Diminished breath sounds, weakened vocal fremitus, hyperresonant percussion.
  • ‌X-ray Findings‌:
    • Mediastinal shift to the healthy side during expiration.
    • “Mediastinal swing” visible during breathing (distinguishes from atelectasis).

‌B. Complete Bronchial Obstruction‌

• Results in ‌obstructive atelectasis‌:
  • Air absorption distal to the blockage causes lung collapse.
• ‌Clinical Signs‌:
  • Flattened chest on the affected side, absent breath sounds, dull percussion.
  • ‌X-ray Findings‌:
    • Mediastinal shift to the affected side.
    • Elevated diaphragm, narrowed intercostal spaces, dense lung shadows.