R. NICKBRYANMDS. JAMESZINREICHMD
Foreign body aspiration is a common clinical entity seen in otolaryngology practice and is a leading cause of accidental death in children younger than 4 years.1 Infants and toddlers younger than 5 years account for 84% of foreign body aspirations, with 73% of the 84% occurring in children younger than 3 years.2 Missed foreign bodies can often result in increased morbidity and mortality. A high level of suspicion is required in a previously healthy child who develops acute respiratory symptoms. A thorough history and physical examination are required and will sometimes help in diagnosis. A choking crisis has been found to have good sensitivity and specificity; however, it is often unwitnessed.3 Presenting symptoms include the sudden onset of choking, intractable cough, fever, and wheezing. Cyanosis is a less common presenting symptom. The diagnostic triad (wheezing, coughing, and decreased breath sounds) has been shown to be absent in 50% of children with airway foreign bodies.4 Patients whose condition is initially misdiagnosed are often treated for pneumonia or asthma.5
Diagnosis Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2001;127(4):457. doi:
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