tial choking and gagging, or
without these, there may be a subjective sense of a foreign body,
constant or, more often, on swallowing. Odynphagia and dysphagia or
aphagia may or may not be present. Pain, sub-sternal or extending to
the back is sometimes present. Hematemesis and fever may occur from
the foreign body or from rough instrumentation. Symptoms referable to
the air-passages may be present due to: (1) Overflow of the secretions
on attempts to swallow through the obstructed esophagus; (2) erosion
of the foreign body through from the esophagus into the trachea; or
(3) trauma inflicted on the larynx during attempts at removal, digital
or instrumental, the foreign body still being present or not.

Diagnosis is by the roentgenray, first without, then, if necessary,
with a capsule filled with an opaque mixture. Flat objects, like
coins, always lie with their greatest diameter in the coronal plane of
the body, when in the esophagus; in the sagittal plane, when in the
trachea or larynx. Lateral, anteroposterior, and sometimes also
quartering roentgenograms are necessary. One taken laterally, low down
on the neck but clear of the shoulder, will often show a bone or other
semiopaque object invisible in the anteroposterior exposure.

[149] CHAPTER XIII--FOREIGN BODIES IN THE LARYNX AND TRACHEOBRONCHIAL
TREE

The protective reflexes preventing the entrance of foreign bodies into
the lower air passages are: (1) The laryngeal closing reflex and (2)
the bechic reflex. Laryngeal closing for normal swallowing consists
chiefly in the tilting and the closure of the upper laryngeal orifice.
The ventricular bands help but slightly; and the epiglottis and the
vocal cords little, if at all. The gauntlet to be run by foreign
bodies entering the tracheobronchial tree is composed of:
1. Epiglottis.
2. Upper laryngeal orifice.
3. Ventricular bands.
4. Vocal cords.
5. Bechic blast.

The epiglottis acts somewhat as a fender. The superior laryngeal
aperture, composed of a pair of movable ridges of tissue, has almost a
sphincteric action, in addition to a tilting movement. The ventricular
bands can approximate under powerful stimuli. The vocal cords act
similarly. The one defect in the efficiency of this barrier, is the
tendency to take a deep inspiration preparatory to the cough excited
by the contact of a foreign body.

_Site of Lodgment_.--The majority of foreign bodies in the air
passages occur in children. The rig