Vol.2, No.6, 341-344 (2013) Case Reports in Clinical Medicine
Glottic foreign bodies in infants: A series of
four cases
Aayush Mittal1*, Rahul Bhargava2, Sunil Kumar2, Jatinder Kumar Sahni2
1Department of Otorhinolaryngology-Head & Neck Surgery, Hind Institute of Medical Sciences & Shekhar Hospital, Lucknow, India;
*Corresponding Author: aayush_mittal@yahoo.com
2Department of Otorhinolaryngology-Head & Neck Surgery, Lady Hardinge Medical College, New Delhi, India;
dr.rahul.bhargava@gmail.com, suku321@rediffmail.com, drjksahni@yahoo.co.in
Received 9 July 2013; revised 5 August 2013; accepted 12 August 2013
Copyright © 2013 Aayush Mittal et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Foreign body in glottis especially in infants is
rare. Retrieval of foreign body is a rather simple
procedure but sharing of the airway with the
anaesthetist and impeding complication makes
it more challenging and dangerous. Making a
diagnosis of foreign body is most challenging in
delayed cases. Complete history and detailed phy-
sical examination along with high index of sus-
picion, in cases of persistent cough, fever, non-
resolving respiratory infection, are needed to
rule out airway especially laryngeal foreign body.
This series of 4 cases is being reported because
of the rarity of the glott is fore ign b od y in infants.
Keyw ords: Foreign Body; Bronchoscop y ; Infant;
Aspiration of foreign bodies in trachea-bronchial tree
is common. Most patients are younger than 4 years old
[1]. In literature, incidence of foreign body of the larynx
has been reported from 0.7% to 6.1% among all aero-di-
gestive foreign bodies [2-4]. Delay in diagnosis of the
foreign body in airway has the potential to make a diffi-
cult situation even more serious [5].
We reviewed the data of 79 patients with suspected
history of foreign body aspiration who presented to the
ENT casualty and pediatric emergency during a period of
one year from August 2011 to August 2012.
In 6/79 (7.59%) patients foreign bodies were retrieved
from glottis, in among these 4/6 (66.67%) patients were
under the age group of one year. All the four patients
presented with the complaint of breathing difficulty of
two days to two months duration (Table 1). Two of them
had a history of choking and change in voice while two
of them had a history of coughing and cyanosis. One of
the patients was being treated for upper respiratory tract
infection in some peripheral hospital with antibiotics and
nebulisation for two months. Another patient was re-
ferred from the pediatric department for non-resolving
respiratory distress of more than one week, the child had
undergone fibreoptic laryngoscopy and was reported to
be normal.
On examination all children were having respiratory
distress of varying proportion however apparent suprast-
ernal and intercostal retractions with biphasic stridor was
present in 2 of the patients. Children were afebrile hav-
ing no cyanosis. No abnormal cry or palpatory thud was
noted over the trachea in any case. On auscultation bilat-
eral air entry was equal in all cases with conducted sound
in 2 cases. Rest of ENT examination as well as systemic
examination was unremarkable.
Routine haematological and urine examinations were
normal. X-ray of antero-posterior and lateral view of soft
tissue neck revealed foreign body in the larynx in only
three patients (Figure 1). Considering the possibility for-
eign body these children were subjected to microlaryn-
goscopy/bronchoscopy under general anesthesia on emer-
gency basis.
During the anesthesia, the children were induced using
inhalational sevoflurane only with oral mask. No endo-
tracheal tube was introduced throughout the procedure.
Under deep inhalational anesthesia, direct laryngoscopy
was done with videolaryngoscope and the foreign body
was visualised entrapped in the endolarynx (Figure 2),
which were removed using the appropriate forceps. The
retrieved foreign bodies included a triangular piece of
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A. Mittal et al. / Case Reports in Clinical Medicine 2 (2013) 341-344
glass, foil of the strip of medicine, a piece of plastic toy,
buckle of belt (Figure 3). Check bronchoscopy was done
after the foreign body removal which was unremarkable
in all except in patient with long standing complaints
(Patient No 1) where raw areas on both cords at middle
third were observed. Subsequently, all children were ob-
served for overnight for any complication. Post-operative
period was uneventful and children were discharged on
Table 1. Demographic profile of cases of foreign body larynx.
S. No. Age/sex Symptoms Duration of symptoms Type of foreign body
Patient 1 11 m, male Breathing difficulty, change of voice, choking 2 months Triangular glass piece
Patient 2 8 m, male Breathing difficulty, change in voice 2 days Foil of strip of medicine
Patient 3 5 m, female Weak cry, breathing difficulty, cyanosis 5 days Piece of plastic toy
Patient 4 9 m, male Breathing difficulty, choking, cough Few hours Buckle of belt
Figure 1. X-Ray Soft tissue neck Lateral view showing the foreign body (FB).
(A) Triangular glass piece; (B) Buckle of belt.
Figure 2. Foreign body (FB) covering the entire glottic chink.
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A. Mittal et al. / Case Reports in Clinical Medicine 2 (2013) 341-344 343
Figure 3. Retrieved foreign bodies. (A) Triangular glass piece; (B) Pieces of plastic toy; (C)
Foil of strip of medicine; (D) Buckle of belt.
next day without any medication.
Foreign body larynx is not a common occurrence.
Brkić [2], Lemberg [3], and Bittencourt [4] reported its
incidence from 0.7% to 6.1% amongst all aero-digestive
foreign bodies. It is prudent to diagnose aero-digestive
foreign bodies as early as possible to minimize potential
life-threatening complications in particular glottic for-
eign body. However, in many cases it is not easy to make
the diagnosis as classical symptoms of choking, wheez-
ing, and decreased breath sounds are absent [6]. The de-
lay in diagnosis is attributable to patients’ behaviour or
circumstances where aspiration was unwitnessed [7].
Once the anaesthesia along with muscle relaxants is
given, foreign body might fall down to subglottis or tra-
chea which is a more difficult area to deal with.
The present case series reviews the prevalence of for-
eign body entrapped in the glottis in children, their pres-
entation and duration of symptoms, and various types of
foreign bodies encountered during their retrieval.
Making a diagnosis of foreign body is most challeng-
ing in delayed cases [5]. Complete history and detailed
physical examination along with high index of suspicion,
in cases of persistent cough, fever, non-resolving respira-
tory infection, are needed to rule out airway especially
laryngeal foreign body. It also requires prior discussion
and delibuation with anaesthetist due to potential diffi-
culty and complication that might occur during the pro-
cedure so that everybody in operating room is mentally
prepared for the worst.
[1] Holinger, L.D. (2007) Foreign bodies of the airway. In:
Kliegman, R.M., Behrman, R.E., Jenson, H.B. and Stan-
ton, B.F., Eds., Nelson Textbook of Pediatrics, 18th Edi-
tion, Saunders Elsevier, Philadelphia, 1769-1770.
[2] Brkić, F., Delibegović-Dedić, S. and Hajdarović, D.
(2001) Bronchoscopic removal of foreign bodies from
children in Bosnia and Herzegovina: Experience with 230
patients. International Journal of Pediatric Otorhinola-
ryngology, 60, 193-196.
[3] Lemberg, P.S., Darrow, D.H. and Holinger, L.D. (1996)
Aerodigestive tract foreign bodies in the older children
and adolescent. Annals of Otology, Rhinology, and Laryn-
gology, 105, 267-271.
[4] Bittencourt, P.F.S., Camargos, P.A.M., Scheinmann, P.
and de Blic, J. (2006) Foreign body aspiration: Clinical,
radiological findings and factors associated with its late
removal. International Journal of Pediatric Otorhino-
laryngology, 70, 879-884.
[5] Franzese, C.B. and Schweinfurth, J.M. (2002) Delayed
diagnosis of a pediatric airway foreign body: Case report
and review of the literature. Ear, Nose & Throat Journal,
81, 655-656.
Copyright © 2013 SciRes. Openly accessible at http://www.sc irp.or g/journal/crcm/
A. Mittal et al. / Case Reports in Clinical Medicine 2 (2013) 341-344
[6] Reilly, J., Thompson, J., MacArthur, C., Pransky, S., Be-
ste, D., Smith, M., et al. (1997) Pediatric aerodigestive
foreign body injuries are complications related to timeli-
ness of diagnosis. Laryngoscope, 107, 17-20.
[7] Esclamado, R.M. and Richardson, M.A. (1987) Laryn-
gotracheal foreign bodies in children, a comparison with
bronchial foreign bodies. American Journal of Diseases
of Children, 141, 259-262.
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