What is the workup for a foreign body stuck in the throat?

Workup for Foreign Body Stuck in Throat

The immediate workup for a foreign body stuck in the throat should begin with assessment of airway patency and respiratory distress, followed by visual inspection of the mouth and throat for visible objects that can be manually removed, and escalation to appropriate interventions based on the patient's level of consciousness and the severity of obstruction. 1

Initial Assessment

Conscious Patient with Effective Cough

• Encourage coughing as this is a physiological response that may be effective and unlikely to cause harm 1
• Monitor closely for signs of deterioration
• Do not interfere with spontaneous coughing efforts

Conscious Patient with Ineffective Cough

1. Back blows: Apply up to 5 sharp blows between the shoulder blades
2. Abdominal thrusts: If back blows are ineffective, perform up to 5 abdominal thrusts (Heimlich maneuver) 1
3. Visual inspection: Look for visible foreign body in the mouth
   • If visible: Manual removal of the item is appropriate 1
   • If not visible: Do not perform blind finger sweeps as they may cause harm 1
4. Alternate between back blows and abdominal thrusts until the obstruction is relieved or the patient becomes unconscious

Unconscious Patient

1. Position the patient: Place on a firm surface when possible
2. Chest thrusts/compressions: Recommended for unconscious adults and children with foreign body airway obstruction 1
3. Visual inspection and manual removal: Look in the mouth for visible foreign body
4. Magill forceps: For healthcare providers with appropriate skills, use Magill forceps to remove foreign body in patients with out-of-hospital cardiac arrest from foreign body airway obstruction 1

Advanced Assessment and Management

Imaging Studies

• Neck and chest X-rays: To identify radiopaque foreign bodies and assess for complications
• CT scan: For better visualization of non-radiopaque objects and surrounding tissue

Endoscopic Evaluation

• Flexible fiberoptic rhinolaryngoscopy: Helpful for visualization of the hypopharynx and larynx 2
• Rigid tracheoscopy/bronchoscopy: Gold standard for removal of airway foreign bodies 3

Special Considerations

Pediatric Patients

• Children, particularly those under 6 years of age, are most frequently affected by foreign bodies 4, 5
• Foreign bodies in children may require removal under general anesthesia 4

Location-Specific Management

• Throat (most common in adults): May require direct visualization with laryngoscopy or esophagoscopy 5
• Ear and nose (more common in children): Often can be removed in emergency department or outpatient setting 4

Complications to Monitor For

• Respiratory distress or complete airway obstruction
• Pneumothorax, pneumomediastinum, or subcutaneous emphysema 3
• Bleeding
• Infection
• Perforation of surrounding structures

Important Caveats

• Avoid blind finger sweeps as they may push the foreign body further down or cause injury to the oropharynx 1
• Do not routinely use suction-based airway clearance devices as evidence for their effectiveness is limited 1
• Approximately 54-73% of foreign bodies may require removal under general anesthesia, particularly those in children or with complex presentation 4, 5
• Foreign body sensation may sometimes be due to other causes such as gastroesophageal reflux disease or anatomical abnormalities like displaced thyroid cartilage 2

When to Refer to Specialists

• Inability to visualize or access the foreign body
• Failed attempts at removal
• Patient with respiratory compromise
• Foreign bodies that are large, sharp, or embedded in tissue
• Need for specialized equipment or general anesthesia 3, 6