Airway foreign bodies in adults

The objective of this study was to evaluate the efficacy of flexible bronchoscopy in the management of tracheobronchial foreign bodies (TFB) in adults (≥16 y) from 1990 through 2002. TFB was defined as the presence of any foreign object below the vocal cords. Patients with gastric aspiration or regurgitation were excluded. We reviewed Mayo Clinic Rochester's medical data retrieval system to obtain information on patients with TFBs. Data abstracted included demographics, clinical symptoms, physical examination findings, bronchoscopic techniques used for extraction, success rates, and complications. A total of 65 adults with TFB aspiration were identified. There were 44 males (68%) and 21 females (32%) with a mean age of 60.8 years. A recognized predisposition to aspiration was evident in 35 patients (54%). The right lower lobe was the most common site for lodgment of aspirated TFB (24 of 65 patients; 37%), followed by the bronchus intermedius in 14 patients (22%), trachea in 7 (11%), left main stem bronchus in 7 (11%), and other locations in the rest. The most common symptom was cough (58 of 65 patients; 89%). The most common finding on physical examination was wheezing, seen in 20 patients (31%). Chest radiographs were obtained in 59 patients (91%) and were abnormal in 54 (92%). TFB was seen or its presence was suggested on the chest radiograph in 19 patients (32%). TFBs extracted included dental pieces in 14 patients (22%), nuts in 12 (18%), corn kernels in 7 (11%), vegetable matter in 7 (11%), bones in 6 (9%), plastic pieces in 4 (6%), pills in 2 (3%), and one each of the following: meat, nail, laryngeal polyp, folded drinking straw, broken piece of an endotracheal tube, broken piece of a voice prosthesis, tracheostomy cleaning brush, foil, surgical staple, surgical pledget, balloon fragment, sunflower seed, and a sewing needle. The flexible bronchoscope was used in 61 of the 65 patients (94%) and was successful in 54 of these patients (89%). Flexible bronchoscopy was unsuccessful in 7 patients, 6 of whom underwent successful TFB extraction by rigid bronchoscopy. One patient required a thoracotomy for the removal of a TFB in the right lower lobe. Complications from bronchoscopy were minimal and consisted of minor bleeding in 3 patients. Flexible bronchoscopic procedures were successful in the extraction of 89% of tracheobronchial foreign bodies in adults. Our experience also indicates that flexible bronchoscopic removal of TFBs in adults can be safely performed with minimal complications.