FOREIGN BODIES IN THE LARYNX These are very common during childhood. In rare cases, they may come from within (inhaled masses of mucus, or ascarides). Any thing that the child plays with, if small enough, may be inhaled into the larynx, such as buttons, needles, seeds, bullets, or particles of bone or food. Food particles may be inhaled if the child is suddenly alarmed while eating and takes a deep inspiration. Small bodies inserted in the nose may also be inhaled into the larynx. Pieces of instruments have entered the larynx during operations on the tonsils. The situation of the foreign body is usually either above or under the glottis. Sharp bodies may penetrate the tissues to such an extent that they are not easily seen or felt.
The symptoms will depend to a certain extent upon the size and shape of the foreign body. In adults, it may remain in the larynx for a period without causing any symptonis. but in children, dangerous symp toms usually develop, even when comparatively small bodies are inhaled.
If the foreign body is not large, the first symptoms may be severe coughing. These paroxsyms of coughing often expel the foreign body. If is it not soon coughed out, a bloody secretion is thrown out, par ticularly in cases of pointed foreign bodies. Pain and spasm of the glottis develop, the laryngeal mucosa becomes hyperxmic, and the tissues around the foreign body become swollen. Hoarseness is also present. A purulent expectoration follows the increased inflamma tion. Cievere inflammatory processes, with serous or phlegmonous anlema, abscess, perichondritis, or erosions of blood vessels may also occur. If healing takes place either spontaneously or after some opera tive procedure, symptoms of stenosis due to the presence of cicatrices often remain. A forcible examination of the larynx is particulary dangerous in this class of cases. Sometimes the lary-nx may be inspected after the use of strong cocaine solutions (20 per cent.), but in little children, retching and excessive mucus seeretion.s are produced, and a general anresthetic for the purpose of performing laryngoscopy, and at the same time removing the foreign body, will have to be employed.
Eucain solutions are not as good as cocaine solutions. If suffocation is not imminent, with patience a laryngeal examination may finally be made. The foreign body may sometimes be felt with the finger. A digital examination is how-ever not without danger.
If the diagnosis of a foreign body cannot be made with certainty, the possibility of a lateral pharyngitis, which also produces the feeling of a foreign body in the throat, must be considered. The diagnosis of this condition may be made by direct inspection and by the course of the disease.
Croup must also be differentiated from this condition. In doubt ful cases, the long-continued coughing and stenosis, and the sudden onset in a healthy child will clear up the diagnosis.
is often unfavorable, because in cases where large foreign bodies are present, suffocation is imminent, and the tardy removal of smaller bodies will be follow-ed by serious syniptoms.
bodies that are not imbedded, may be ex pelled during coughing. Even when imbedded, the resulting suppurative process may loosen them so that they are thrown out. The use of emetics is not without danger, because a deep inspiration may carry the foreign body further down. This is also a danger during attempts to remove the body-, and it should not be extracted until it is firmly grasped in the blades of the forceps. Some form of laryingeal forceps is best for this purpo.se.
In children how-ever, when the larynx cannot be directly inspected, this method of removing foreign bodies is not feasible. Tracheotomy and the removal through the wound is best. When pieces of metal have been inhaled, a magnet may be used through the wound.
When there is danger of suffocation, tracheotomy, even in cases of larger foreign bodies, is indicated before attempts to locate the body are made. In cases of impacted foreign bodies, the wound may have to be enlarged upwards, care being taken to protect the vocal cords. After removal, the hyperxmia may be relieved by ice compresses and ice in the mouth.
Adrenalin may have a valuable place in this respect in the future.