BackgroundManaging patients with aural foreign body (AFB) may pose a dilemma regarding which removal technique to use for different AFB types. The current study comprises a review of all the possible methods one could employ in removing AFB. My aim was to describe the best methods for different types of AFBs, complete with a description of the method and tool(s) required, and descriptions of the AFBs for which they are best used.Materials and methodsThe medical literature published between 2000 and 2016 was reviewed using Medline, Cinahl, Embase, Cochrane, PubMed, and Scopus to compile a list of all published AFB removal methods.ResultsTen methods were identified and described, each having their own advantages for different AFBs. Patients normally permit very few attempts, so the first AFB removal attempt should ideally be the only one.ConclusionThere is no single method guaranteed to work with all AFBs, so this report also contains a flowchart to aid deciding which technique to use.

Paradoxical Vocal Fold Movement Disorder is where the larynx exhibits paradoxical vocal cords closure during respiration, creating partial airway obstruction. Causes of vocal fold movement disorder are multifactorial, and patients describe tightness of throat, difficulty getting air in, have stridor, and do not respond to inhalers. We propose using transnasal laryngoscopy examination, which will show narrowing of vocal cords on inspiration, and The Pittsburgh Vocal Cord Dysfunction Index with a cutoff score of ≥4 to distinguish vocal fold movement disorder from asthma and other causes of stridor. Management of paradoxical vocal fold movement disorder involves a combination of pharmacological, psychological, psychiatric, and speech training. Paradoxical vocal fold movement disorder is a very treatable cause of stridor, so long as it is identified and other organic causes are excluded.

ObjectiveThe removal of nasal foreign bodies (NFBs) can be a difficult task for the inexperienced physician, and the more unsuccessful attempts are made, the more difficult the extraction becomes. We have formulated this simple “four-step” approach to improve success, especially on the first try.MethodsA retrospective review of cases requiring NFB removal, seen by one registrar from 2012 to 2016 at Frankston Hospital, was performed.ResultsFrom 2012 to 2016, 93 patients were referred, of whom 65 were confirmed to have NFBs. In all, 20 patients were first seen by the registrar and had the NFB removed successfully. Another 28 patients were referred to the registrar only after one failed attempt by another medical personnel, and the remaining 17 patients were referred after two failed attempts. All patients had the NFB removed locally in the emergency department using the “four-step” approach, except four patients who had the NFB removed under general anesthesia in the operating theater. Three of the latter had two failed attempts and had refused further attempts, and the fourth patient had developed epistaxis after a failed removal by his general practitioner.ConclusionWhen performed correctly, the “four-step” approach will result in the successful removal of NFBs. Ideally, the removal of NFBs should only be performed by an experienced medical personnel, and any failed first attempt removals must be subsequently managed only by an experienced medical personnel.