Foreign Bodies
Amina Lalani
Introduction
If early attempts at foreign body removal are unsuccessful, consider referral and/or procedural sedation
Nose
Usually history of putting object into nose
Persistent, unilateral, foul-smelling, purulent rhinorrhea: nasal foreign body until proven otherwise
Usually visible in anterior nares; may have to suction purulent secretions
Radiographs not helpful; most foreign bodies are radiolucent
Techniques for Removal
Standard: curette, alligator forceps, suction, right-angle hook
Alternative methods for removal:
Nasal positive pressure techniques
Magnetic removal
Glue
Removal of Nasal Foreign Bodies
Adequately restrain child
Apply topical anesthetic and vasoconstrictor
2% lidocaine
Phenylephrine or xylometazoline
Use nasal speculum and headlight
Equipment: curette, alligator forceps, suction, or hook
Do not push/irrigate into posterior nasopharynx in case of aspiration
Consider amoxicillin to prevent/treat infection after removal of long-standing FB
Complications: rhinosinusitis, laceration, epistaxis, aspiration, incomplete removal
Nasal Positive Pressure Techniques
Older child: ask child to blow nose while occluding unaffected side
Apply self-inflating bag-valve mask over mouth only and give positive pressure ventilation
Parent blows into child’s mouth: 80% success rate in one study
Magnetic Removal of Nasal Foreign Bodies
Magnet can be applied to nostril to remove metallic FB
Avoids need for anesthetic, easy and safe
Ear
Mostly solid objects: stones, beads, erasers
Live insects may also enter canal
Round objects can be removed with warm water irrigation
Not if suspected perforation, ear tube, or object has potential to swell (e.g., vegetative matter)
Methods of Removal
Ear curette, alligator forceps, irrigation, suction, glue
Soft Tissue
Earrings, lip and tongue studs
Grasp and remove earring stud from posterior, mucosal, or inferior aspect
Thread front of earring forward through soft tissue to remove
May require local anesthesia and small incision
Digit
Strangulating Ring
Three removal techniques: ring cutting, string compression, string pull
Ring Cutting
If minimal edema distal to ring, try other techniques first
Digital block, insert ring-cutter guard
Place blade on ring and apply pressure while rotating blade of ring cutter
If hard metal, watch for heating with friction
After ring is cut through, pull apart manually or use hemostat to remove
Complications: vascular compromise, trauma to digitRelated posts:
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