“How to remove those things children put up their nose” (J Fam Pract. 2009;58:315-316) nicely summarized nasal foreign body removal. But author David A. Randall omitted what I consider to be the most important extraction tool: a parent’s mouth. If the embedded item is a small pebble, seed, or other object, the mother or father is often able to blow it out of the child’s nostril with relative ease.
Staying across the room in order to avoid upsetting the patient, I instruct the parent to gently lay the child on the exam table and approach playfully—as if he or she is about to kiss the child. Gently but firmly, the parent occludes the unobstructed nostril, seals her lips over the child’s mouth, and quickly blows in, using only the cheek muscles—not the diaphragm. This works best if the child’s head is flexed down so the air moves from mouth to nasal cavity.
The first attempt should be of short duration. If it’s unsuccessful, the parent should giggle so the child thinks it’s a game, then quickly try again.
I always try this approach before attempting manual extraction of a nasal foreign body. When it works, the parent thinks you’re a genius. True, you’ll only be able to charge for an office visit—not a procedure—but you’ll have a happy parent and child.
Jon Ahrendsen, MD, FAAFP
Clarion, Iowa
Dr. Randall responds
I appreciate my colleague’s comment regarding the use of positive pressure from the parent, although I have no personal experience with this technique.
Botma et al1 described satisfactory use of this technique in 15 of 19 pediatric patients. We all seek to optimize patient satisfaction while minimizing distress to the child and parents. This appears to be a very reasonable option to present to the parents as an initial alternative to manual extraction.
David A. Randall, MD
Springfield ENT and Facial Plastic Surgery
Springfield, Mo