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Nasal foreign Body Removal

Antonio Riera, MD, Mizuho Morrison, DO, and Donald Jacobson, RN
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13:12

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Review the hazards associated with button battery foreign bodies in the nares. Discuss common techniques for nasal foreign body removal in children as well as learn from a case report of a clever new technique used for removal of metallic foreign bodies.

Highlights

  • Button batteries are a dangerous foreign body (FB).

  • Traditional removal techniques include positive pressure and direct removal techniques.

  • A novel approach, using an earth magnet attached to a nasal trumpet and speculum handle, has been reported for use with button battery removal.

 

Introduction

  • Kids love sticking things up their noses.

  • Button batteries cause corrosion and coagulation necrosis of any moist esophageal, GI, nasal, or ear mucosa. Within the nasal cavity we are always concerned about the risks of septal perforation or necrosis, and therefore they need to be removed as soon as possible.

 

Removal Techniques

  • Regardless of technique, Spangler likes to have patients stand up or seated upright in the bed with an adult behind them to help restrain them and hold their head up in a sniffing position, so that you don’t cause aspiration of the foreign body when you attempt any of these techniques.

  • Complications include minor trauma, abrasions, lacerations, epistaxis, infection, pushing the object deeper, and, worst of all, aspiration.

  • Positive pressure expulsion techniques

    • Parent’s kiss is a method of mouth-to-mouth blowing of air by the parent into the kid’s mouth, while the good nostril is occluded. Studies demonstrate a 60% success with very few complications.

    • An Ambu bag, or the bag-valve mask method, is the same idea as the parent’s kiss using a bag valve mask, instead of mouth-to-mouth.

    • Older patients may be able to follow instructions and forcibly blow their nose while you occlude the patent nostril.

  • Direct removal techniques

    • Alligator forceps are good for any FB that is non-organic and compressible, like a piece of foam or soft moldable piece of plastic that you are able to catch the edge on. They are not for round, smooth objects that have a hard surface because you can actually push those foreign bodies farther back.

    • Balloon-tipped catheter, like an infant 6-French Foley may be used. Add a tiny bit of surgical lubricant to the tip of it, and gently insert it into the nose, on the nasal septum side of the FB. Once the balloon is past the FB, inflate the balloon, and remove the Foley from the nostril with constant but gentle pressure, dragging the FB out with it.

    • Irrigation with saline and suction technique has a risk of aspiration and is not recommended by Spangler.

 

CASE:

A 3three-year-old female was taken to the Emergency Department by her mother after inserting an object initially thought to be the back of an earring into her right nostril. The object was unable to be removed with a 6-French foley catheter, despite pre-medication with topical phenylephrine given to reduce nasal mucosal edema. After unsuccessful removal attempts with a foley catheter, an x-ray was done and was concerning for a button battery. At this time, a device fashioned from a curette handle with a nasal trumpet and an earth magnet at the tip was used to successfully remove the button battery. The patient was discharged on antibiotics and close follow-up without complications.

Alletag MJ, et al. Nasal disc battery removal: a novel technique using a magnetic device. Pediatr Emerg Care. 2014 Jul;30(7):488-90. [PMID: 24987992]

 

Dr. Alletag, Dr. Riera, and nurse Donald Jacobson report a novel technique in Pediatric Emergency Care in 2014

 

  • How did you come up with the idea for this gadget?

    • They had a patient who had a metallic object in her nose and they could not get it out. The author thought of a tool at home that is like a long telescopic rod with a magnet on the end, so if you dropped nuts and bolts when you are working on your car, you can pick them up with that.

  • How was this device assembled?

    • He put the magnet in the end of a nasal trumpet, and put the other end of a cut- off nasal trumpet under the plastic rod, wrapped some suturing material around it very tightly so it couldn’t slip off.


*Editor’s note: The content in this segment are solely those of the authors/contributors. The device/technique described is published as a case report and is not an FDA- approved device nor have safety studies been conducted. Listeners/readers are warned to use this information at their own risk.

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