We intended to identify the types and incidence of complications associated with foreign bodies (FBs) impacted in the upper aerodigestive tract (UADT) and to ascertain factors predisposing to the development of these complications. The design was a retrospective cohort study of 327 patients with UADT foreign bodies admitted to a tertiary care center. The overall incidence (7.6%) and types of complications varied by age. Complications developed in 4.8% of 208 patients 10 years of age and under, with pulmonary complications being most common. In contrast, complications occurred in 12.6% of 119 older patients, with retropharyngeal abscess being the most common (p < .0001). Delayed presentation (> 24 hours after the onset of symptoms) was the only factor associated with an increase in the incidence of complications in the younger patients (p = .02). In contrast, pharyngeal location of the FB (p = .0004), the FB's being a fish bone (p = .006), and radiolucency (p = .02) were all associated with an increased incidence of complications in patients over 10 years of age. A significant risk for complications is present for patients admitted for the management of FBs in the UADT. Older patients with sharp FBs are at greatest risk. In this group of patients, close observation in the perioperative period is required, especially if there is evidence of mucosal injury.

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A bst ract With advances in medi cal techn ology and increasing numbers of elderly patient s surviving acut e intensive care unit admissions, otolaryngolog ic consultat ion rega rdin g trach eostomy fo r ventilato r-dependen t patients is expected to continue increasin g. Ho wever, established treatm ent guide lines and defin ed out com es in term s of health status, qua lity of life, and medi ca l costs are lacking in this emotionally delicate setting. A retrospective case review of the outcomes of 19 elderly pati ents who underwent trach eostomyfor ventilator dependence revealed that 14 had died within 40 days of surg ery. The high number of deaths-which were caused by multiple organ f ailure, sepsis, and/or card iopulm onary arrest-so soon after tracheostomy demands the implementation of outcomes research. In this article, we introdu ce outcomes analysis as a means of assessing the utility oftracheostomy for ventilator dependence in the elderly and to advo cate the establishment of a multidisciplinary palliative-care unit for this group of pati ents. Case reports Case 1. A 75-year-o ld man was adm itte d with a