Letters to the Editor

Indian Pediatrics 2002; 39:1080-1081

Foreign Body in the larynx

I read with interest the article on foreign body in the larynx(1) and shall like to point out certain ambiguities in the letter published.

The authors’ claim that it was a case of several coins in the larynx is not tenable for several reasons:

1. The X-ray of the chest provided shows very large coin shadows which are bigger than the size of respiratory passages in any neonate.

2. Further the X-ray shows that the coins are reaching beyond the carina which should make it a case of foreign bodies in the trachea. However even this is not possible because the tracheal coin foreign bodies are likely to be seen end on as the glottic opening can not allow the entry of any coin along the coronal plane as is seen in the X-ray provided.

3. Based on the facts provided it could at best be a case of foreign body in the esophagus which can present with respiratory distress due to extraneous pressure on the respiratory passage. Further one can see another coin shadow almost near the lower end of the esophagus in the X-ray.

4. Based on my experience with management of foreign bodies, I feel that the claims of the authors that the patient improved after removal of foreign bodies with direct laryngoscopy alone are not maintainable. The coins are much lower into the esophagus to be approachable by simple laryngoscopy, particularly the one stuck at middle or lower end of the esophagus.

References

1. Singh VK, Kumar R, Suman S, Issar DK, Choudhary DK. Foreign body in the larynx of a one-day-old baby presenting on day 15 of life. Indian Pediatr 2002; 39: 314-315.