Objective: To describe the clinical features of pen cap aspiration and removal techniques. Study design: We retrospectively reviewed all children with a history of inhaling a pen cap who were referred to the ENT department, at Beijing Children's Hospital, between Jan 2006 and Dec 2010. Methods Clinical data was recorded, including patients' common information, physical examination, radiologic data and final outcome. Results: Data from 44 children, with a median age of 8.7 years of age (35 months to 12 years) and a male-female ratio of 7.8:1 were analyzed. The time between inhalation and diagnosis with extraction of the foreign body ranged from several hours to 6 years, but 75% (33/44) were seen within one week. 89% (39/44) had pen caps removed by rigid bronchoscopy undergeneral anesthesia. Reverse grasping forceps were used in 62% of the cases and ordinary forceps in 38% of the cases (24/15, p < 0.05). In 2 cases, the pen caps were coughed up. In 2 cases the FB was removed via a tracheotomy and in 1 case by thoracotomy. Conclusions: Pen caps are an unusual foreign body in the airway, occurring frequently in school age children. Rigid bronchoscopy under general anesthesia with reverse grasping forceps was the most favorable method for extraction of pen caps, but open surgical approaches should be available. (C) 2012 Elsevier Ireland Ltd. All rights reserved.