Problems in the management of aspirated foreign bodies.

Observations on nineteen cases of foreign bodies in the air passages have been presented. These mostly got lodged in the right bronchus (42.1%) and larynx (36.8%) while the commonest presenting complaint was respiratory distress. As many as 57.9 percent of our cases were aged two years or less. Large foreign bodies (above 20mm. size) were held up in the oropharynx; irregular and pointed medium sized objects (8-15mm) got stuck in the larynx while small, smooth or linear ones descended to the right bronchus. Absence of positive history, inconsistent clinical features and radiolucency of objects caused difficulty in diagnosis. Slow induction and laryngeal or bronchial spasm during anaesthesia, and fragmentation or impaction of the foreign body posed problems during endoscopic removal. Subglottic, tracheal or laryngeal inlet mucosal oedema were observed after removal of foreign body in six cases. A plea has been made to have a high degree of suspicion of foreign bodies in every child with respiratory symptoms of sudden onset. Endoscopy at the earliest has been recommended for prompt diagnosis and treatment.