estion is of a kind dense to the ray or
not.
4. Do not fail to search endoscopically for a foreign body in all
cases of doubt.
5. Do not pass blindly an esophageal bougie, probang, or other
instrument.
6. Do not tell the patient he has no foreign body until after
roentgenray examination, physical examination, indirect examination,
and endoscopy have all proven negative.

SUMMARY

SYMPTOMATOLOGY AND DIAGNOSIS OF FOREIGN BODIES IN THE AIR AND FOOD
PASSAGES

_Initial symptoms_ are choking, gagging, coughing, and wheezing, often
followed by a symptomless interval. The foreign body may be in the
larynx, trachea, bronchi, nasal chambers, nasopharynx, fauces, tonsil,
pharynx, hypopharynx, esophagus, stomach, intestinal canal, or may
have been passed by bowel, coughed out or spat out, with or without
the knowledge of the patient. Initial choking, etcetera may have
escaped notice, or may have been forgotten.

_Laryngeal Foreign Body_.--One or more of the following laryngeal
symptoms may be present: Hoarseness, croupy cough, aphonia,
odynphagia, hemoptysis, wheezing, dyspnea, cyanosis, apnea, subjective
sensation of foreign body. Croupiness in foreign body cases, as in
diphtheria, usually means subglottic swelling. Obstructive foreign
body may be quickly fatal by laryngeal impaction on aspiration, or on
abortive bechic expulsion. Lodgement of a non-obstructive foreign body
may be followed by a symptomless interval. Direct laryngoscopy for
diagnosis is indicated in every child having laryngeal diphtheria
without faucial membrane. (No anesthetic, general or local is needed.)
In the presence of laryngeal symptoms, think of the following:
1. A foreign body in the larynx.
2. A foreign body loose or fixed in the trachea.
3. Digital efforts at removal.
4. Instrumentation.
5. Overflow of food into the larynx from esophageal obstruction due
to the foreign body.
6. Esophagotracheal fistula from ulceration set up by a foreign body
in the esophagus, followed by the leakage of food into the
air-passages.
7. Laryngeal symptoms may persist from the trauma of a foreign body
that has passed on into the deeper air or food passages or that has
been coughed or spat out.
8. Laryngeal symptoms (hoarseness, croupiness, etcetera) may be due
to digital or instrumental efforts at the removal of a foreign body
that never was present.
9. Laryngeal symptoms may be due to acute or chronic laryngitis,
diphtheria, pertussis,