Positive pressure technique for removal of nasal foreign bodies

Efficacy and safety of the “mother’s kiss” technique: a systematic review of case reports and case series

“…exclusion is provided in Appendix 2, available at www .cmaj .ca /lookup /suppl /doi :10 .1503 /cmaj .111864 /-/DC1). 1,[11][12][13][14][15][16][17][18] Two of these studies were prospective case series with consecutive enrolment of patients, 1,12 3 were retrospective case series, 13-15 1 was a case series for which it was unclear whether it was prospective or retrospective, 16 and 2 were case reports 17,18 (Table 2). We excluded 14 studies, 7 of which were not written as formal case series and did not provide sufficient information to allow us to assess them adequately (such as success rates), 4 were review articles, and 3 gave only a description of the technique.…”

“…However, 2 of the included studies stated that a fully obstructing object is much more likely to be propelled out of the nose than an irregularly shaped object that spans the nostril but permits air to pass. 13,16 In addition, irregularly shaped objects tend to be easier to grasp.…”

“…For example, 4 of the included studies only involved children presenting to the emergency department, which may deal with less complicated cases than would an ear, nose and throat specialist. 1,13,15,16 Although the overall number of children who had a previous attempt at removal of the foreign body before the mother's kiss was attempted was given in all but 3 of the studies, 13,15,16 there was no attempt to correlate these numbers with the subse- quent successfulness of the technique. In addition, the length of time since an object's insertion and the location of the object in the nasal cavity are likely to be important factors in successful removal.…”

“…No adverse events were reported in the included studies, although a number of theoretical risks of the technique have been documented, such as barotrauma, both to the tympanic membranes and to the lower airways. 16,17,[19][20][21] However, a ruptured tympanic membrane or pneumothorax resulting from this technique has never been reported. The glottis is closed during the technique, so there is little risk of barotrauma to the lungs.…”

Continuous negative airway pressure “CNAP”: Novel nasal foreign body removal

“…It has a 40% failure rate, with many children eventually being admitted to the emergency department. 5,6 Techniques employed in the emergency department include the use of positive-pressure techniques (via the kissing technique, an Ambu bag, or nasally applied pressure through a catheter or oxygen source), and washing out with nasally applied saline. Direct mechanical extraction is possible with alligator forceps, hooks, or balloon-tipped catheters.…”