Foreign Body in the Throat

What to do right now

If the person is choking

Someone with a partly blocked airway who can still cough forcefully should be encouraged to keep coughing. Do not slap their back or put your fingers in their mouth while they are coughing well.

If they cannot breathe, speak or cough:

1. Ask someone to call 911 or your local emergency number.
2. Adults and children over 1 year: give up to 5 firm back blows between the shoulder blades, then up to 5 abdominal thrusts (the Heimlich maneuver). Alternate until the object comes out or the person becomes unresponsive.
3. Babies under 1 year: hold the baby face down along your forearm with the head lower than the chest. Give 5 back blows, then turn the baby over and give 5 chest thrusts with two fingers on the breastbone. Never use abdominal thrusts on a baby.
4. If the person becomes unresponsive: lower them to the floor and start CPR. Look in the mouth before rescue breaths and remove an object only if you can see it.

Even after successful first aid, the person should be checked by a doctor, because thrusts can injure internal organs and fragments can remain.

If the object is stuck but breathing is normal

• Do not try to push it down with bread, bananas or more food. This can drive a bone deeper or make an impaction worse.
• Do not make the person vomit.
• Small sips of water are fine if they can swallow. If they cannot swallow their own saliva, give nothing by mouth and go to the ER.
• Keep what is left of the object or its packaging (for example a battery pack) to show the doctor.

Where objects get stuck

An object in the airway is called foreign body aspiration. It is more dangerous than one in the food pipe and can cause pneumonia if it goes unnoticed.

Symptoms

In adults

• a sudden sharp pain or a feeling that something is lodged, often pointing to a specific spot
• pain or difficulty swallowing (dysphagia)
• gagging, retching or bringing back saliva and food
• drooling because saliva cannot pass
• pain in the neck or behind the breastbone
• coughing, hoarseness or wheezing if the airway is involved

In babies and young children

Children often cannot say what happened. Watch for sudden coughing or gagging during play, refusing food or drink, drooling, vomiting, pointing to the throat or chest, noisy breathing or a new wheeze. A coin may cause surprisingly few symptoms, so an X-ray is usually done whenever swallowing is suspected.

Sensation of a foreign body in the throat with nothing there

A scratch from a bone or a hard crust can leave a feeling that something is still stuck for 24 to 48 hours after the object has gone. A long-lasting lump feeling with no swallowing event is a different problem, often called globus, and is covered on our page on lump in throat. It is commonly linked to reflux, muscle tension or postnasal drip and does not make swallowing food difficult.

Who is at risk

• Young children put objects in their mouths and have narrow airways and gullets.
• Adults with dentures, which reduce the ability to feel bones in food.
• People with esophageal narrowing, such as eosinophilic esophagitis, an esophageal stricture or a Schatzki ring. Recurrent meat impaction is often the first sign.
• People who eat quickly or drink alcohol with meals, and older adults with swallowing problems after a stroke or with dementia.
• People with certain mental health conditions or in prison, who may swallow objects on purpose.

How doctors diagnose it

The doctor asks what was swallowed, when, and whether you can swallow saliva. They look in the mouth and may use a small mirror or a thin flexible camera through the nose (nasendoscopy) to see the tonsils, tongue base and voice box, where most fish bones lodge.

• X-rays of the neck, chest and abdomen show metal objects, batteries and some bones. A battery shows a "double ring" outline that separates it from a coin.
• CT scan finds bones and objects that X-rays miss and shows complications such as a perforation.
• Endoscopy (a camera passed through the mouth) both confirms and treats the problem.

Many fish bones and plastic objects do not show on X-ray, so a normal X-ray does not rule out a foreign body if symptoms persist.

Treatment

Removal

• Fish bones in the tonsil or tongue base are usually removed with forceps in clinic, often after numbing spray.
• Objects and food in the esophagus are removed by flexible endoscopy, usually under sedation. Guidelines advise removing sharp objects, button batteries and complete blockages (unable to swallow saliva) as an emergency, ideally within 2 to 6 hours. Other food impactions should be cleared within 24 hours.
• Rigid endoscopy under general anesthetic is used for some objects in the upper esophagus and for anything in the airway (bronchoscopy).

Objects that have passed into the stomach

Once a smooth object such as a coin reaches the stomach, it usually passes in stool within a week. Your doctor may ask you to watch for it and repeat an X-ray if it has not appeared. Long or sharp objects, magnets and batteries in the stomach may still need removal. See foreign body in the gastrointestinal tract.

After removal

Expect a sore throat for a day or two. Adults who had a food impaction need a follow-up biopsy or endoscopy to look for an underlying cause, because recurrence is common if it is not treated.

Complications

• Button battery burns: a lithium battery can burn through the esophagus wall within 2 hours. Honey given at home (for children over 1 year) while traveling to the ER can reduce damage, per poison center guidance, but must not delay care.
• Esophageal perforation: a tear from a sharp object, causing severe chest pain, fever and air under the skin of the neck.
• Deep neck infection such as a retropharyngeal abscess, or infection in the middle of the chest (mediastinitis).
• Aspiration pneumonia from an unnoticed object in the airway.
• Narrowing (stricture) from scarring after injury.

Prevention

• Keep coins, button batteries, magnets and small toy parts out of reach of children under 4. Check that battery covers are screwed shut.
• Cut food for young children into small pieces. Halve grapes and cherry tomatoes lengthwise and avoid whole nuts and popcorn under age 4 to 5.
• Fillet fish carefully and chew slowly, especially with dentures.
• Get recurrent food sticking investigated rather than waiting for a full impaction.

Frequently asked questions

What does a foreign body in the throat feel like?

It usually feels like a sharp prick or a lump at a specific point that worsens when you swallow. You may gag, drool or be unable to swallow saliva. Food stuck lower down feels like pressure behind the breastbone. A mild scratchy feeling after a meal that slowly fades over a day is often just a scratch from a bone that has already gone.

Will a fish bone in the throat go away on its own?

Small bones often pass or dislodge within hours, and the scratch they leave can mimic a stuck bone for a day or two. If pain is sharp, localized, getting worse, or still there after about 24 hours, see a doctor. Do not swallow bread to push it down, as this can lodge the bone more deeply.

Why is a swallowed button battery so dangerous?

A coin-shaped lithium battery stuck in the esophagus creates an electrical current in the tissue that burns through the wall within hours. This can damage major blood vessels and the airway. Anyone who may have swallowed one needs emergency X-ray and removal, even without symptoms.

How do doctors remove something stuck in the throat?

Bones near the tonsils are pulled out with forceps after numbing the throat. Objects or food in the esophagus are removed with a flexible endoscope, usually under sedation, using graspers, nets or baskets. Airway objects need bronchoscopy under general anesthetic.

What is the sensation of a foreign body in the throat with nothing stuck?

This feeling, called globus, is a persistent lump or tightness in the throat without trouble swallowing food. Reflux, muscle tension, anxiety and postnasal drip are common triggers. See a doctor if it lasts more than a few weeks or comes with pain, weight loss, voice change or real difficulty swallowing.

Is it an emergency if food is stuck but I can breathe?

It is urgent rather than an emergency if you can breathe and swallow saliva. Go to the ER if food has not passed within a couple of hours, if you are drooling or cannot swallow saliva, or if you have chest pain. Prolonged impaction increases the risk of injury to the esophagus.