The art of removing nasal foreign bodies

Abstract

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.

Unexpected nasal foreign body

“…This is partly due to the fact that most people are right-handed, as in our presented case. This laterality is similar in cases involving auricular foreign bodies (10) .…”

“…The time of presentation is very important, as prolonged foreign body presence leads to more complications. The predictors of successful removal of foreign body in the outpatient or emergency setting include the first attempt by an experienced person (10) . Extensive manipulations aimed at foreign body removal by unskilled physicians or ordinary individuals will typically result in more complications (11) and ultimately require the removal to be performed under general anaesthesia in the majority of cases (7) .…”

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“…Such foreign bodies are generally seen in the pediatric population but seldom in adults. 1 A living organism is a rare type of Harun NP127 foreign body. We described 19 cases of leech infestation and the clinical features.…”

“…A foreign body in the upper airway is a common clinical presentation in otolaryngology practice, with the recognition and removal of a foreign body an important part of daily practice for ear, nose, and throat (ENT) residents and otolaryngologists. 1 The most commonly encountered inanimate foreign bodies include beads, pieces of paper, rubbers, legumes, and small parts of toys. 2 In the pediatric population, an upper airway foreign body may be life threatening if it moves to the trachea or bronchi or obstructs the rima glottis.…”

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“…237 Removal may require general anesthesia, especially in cases of prolonged impaction because of associated inflammation. 238 Ciliary dyskinesia. Ciliary dyskinesia can be primary or secondary.…”