20 ways of removing a nasal foreign body in the emergency department

Background: Nasal foreign body (NFB) is a common presentation to the emergency department (ED). It is often a dilemma for the treating physician to choose the best method as removal of NFB can be challenging, frustrating and distressing for the physician, the patient, and the patient’s parents. Method: We have listed the 20 possible methods one could use to remove NFB in an ED setting. Results 1. Positive Pressure (Child) Method 2. Positive Pressure (Parent) Method – Also known as the kissing technique 3. Modified Positive Pressure (Parent) Method – It is a modification to the kissing technique 4. Positive Pressure with Ambu bag 5. Positive-Pressure Device 6. Beamsley Blaster Positive-Pressure Device 7. Saline Washout Technique 8. Cyanoacrylate (super glue) 9. Catheters 10. The Katz extractor 11. Using a Magnetic Device 12. Instrumentation – Alligator/Crocodile forceps 13. Instrumentation – Tilley nasal packing forceps 14. Instrumentation – Jobson-Horne Probe / ring curette / wax loop 15. Instrumentation – Right angle probe 16. Instrumentation – Frazier suction catheter 17. Instrumentation – Cut-down flexible suction catheter 18. Instrumentation– Refashioned / bent paper clips 19. Snare Technique Wire loop snare grasped by hemostat 20. ‘‘Hook-Scope’’ Technique for Endoscopic Extraction of NFB Discussion: Any of the chosen methods has its own benefits and most are suitable for some but not all NFB shapes. In addition, for the removal of NFB with any technique to be successful, four prerequisite needs to be fulfilled which are: a well restrained patient, a good head light with optimal illumination, a nasal speculum and decongested nasal cavity. Conclusion: The child usually allows only one or two attempts at most for removal of NFB, hence assess the child carefully and if you do not feel you are the right person for the job, get help from seniors or direct referral to the ENT team should you anticipate a difficult removal of a NFB. Correspondence to: Dr. Tian-Tee Ng, ENT Unit, Department of Surgery, Frankston Hospital, Frankston 3199, Victoria, Australia, Tel: +61-0426 266 890; E-mail: [email protected]