Chapter 169. Nasal Foreign Body Removal

Nasal foreign bodies are commonly seen in children, particularly those between 1 and 4 years of age. Adult patients with mental retardation or psychiatric illness can also present to the Emergency Department with a nasal foreign body. Young children are naturally curious and spend a great deal of time investigating themselves and the world around them. This involves handling, tasting, and smelling whatever they get their hands on. When these investigations go too far, the Emergency Physician is faced with a foreign body in a youngster's nose. The most common foreign bodies found are beads, food (e.g., corn, nuts, peas, and popcorn), paper, rocks, and toy parts.1,2 Nasal foreign bodies also result from attempts to clean the nose and to control bleeding. In these cases, most of the foreign bodies retrieved consist of cotton swabs, paper, or sponge material.

Children may present with a known nasal foreign body. However, other presentations are common and may be subtle. This includes body odor, halitosis, persistent unilateral nasal discharge, or recurrent epistaxis. Foreign bodies can be found during a routine examination or as an incidental finding on radiographs in the asymptomatic child.1,3,4

The task of the Emergency Physician in these cases is fourfold. First is to suspect the presence of a nasal foreign body. Second is to perform a thorough physical examination, including a search for the foreign body. Next is to visualize the foreign body. Finally, remove the foreign body efficiently and with minimal trauma.

The nasal cavity consists of two passages on either side of the nasal septum. The superior, middle, and inferior bony turbinates project medially into each passage and are covered by a mucous membrane overlying a venous plexus. Although foreign bodies can be located anywhere in the nose, most foreign bodies are found on the floor of the inferior turbinate or anterior to the middle turbinate.5 The cartilaginous septum is covered by a thin mucosa and receives its blood supply from the mucoperichondrium. Sensory nerves of the nasal cavity are branches of the greater palatine nerve and sphenopalatine ganglion.6 These nerves are easily anesthetized with topical anesthetics. The nasal cavity is separated from the orbit by the thin lamina papyracea and from the anterior cranial fossa by the cribriform plate of the ethmoid bone.

A foreign body in the nasal cavity sets off an inflammatory response and the venous plexus becomes congested. This swelling may eventually obscure the foreign body from view. The longer the foreign body remains in the nasal cavity, the more likely the patient is to develop pressure necrosis, granulation tissue, infection, and a purulent discharge. The foreign body can erode into the surrounding areas over time if it is not removed. A unilateral malodorous discharge and/or epistaxis from a child's nose is the hallmark of a foreign body.

The presence of a disk or button battery in the nasal cavity requires urgent removal. These batteries contain a strong alkali, usually potassium hydroxide or sodium hydroxide. The moisture in the nasal cavity may cause corrosion of the battery, leakage of the battery contents, and a low-voltage direct current between the anode and cathode. This may cause liquefaction necrosis, tissue electrolysis, and tissue destruction (mucosa, cartilage, and bone) within hours.6 These patients need to be seen and followed by an Otolaryngologist after the battery is removed. An electrical thermal burn may cause damage to the nasal tissues that is more extensive than is visible initially in the Emergency Department.7,8 Patients may develop a delayed septal perforation and alar collapse from extensive tissue damage.9

Small magnets can produce pressure necrosis in the tissues, particularly when they span either side of the cartilaginous septum or a turbinate. These magnets are commonly used as beads, clasps for necklaces and bracelets, and in faux piercings.10,11

All nasal foreign bodies must be removed to prevent complications. The direct observation of a foreign body in one or both nostrils is an indication for its removal. The presence of signs or symptoms such as unilateral persistent nasal discharge, recurrent unilateral epistaxis, halitosis, or an unusual body odor should prompt a search for a nasal foreign body. More than 90% of nasal foreign bodies can be removed by the Emergency Physician with readily available equipment.1,3

There are a few contraindications to the removal of a nasal foreign body in the Emergency Department. One contraindication is if the airway is in danger. Do not attempt to retrieve a nasal foreign body if the patient is in distress or unstable. This might be due to a posteriorly placed foreign body or an uncooperative patient. Management of the airway in the Emergency Department or in the Operating Room must take priority to foreign body removal.

An Otolaryngologist should be consulted in patients with nasal foreign bodies that are impacted, cause excessive bleeding, or have resulted in nasal perforation or penetration. Foreign bodies located posterior and superior to the middle turbinate pose a risk of being pushed back during retrieval and may perforate the cribriform plate. If a larger foreign body has entered the nose traumatically, it should be removed by an Otolaryngologist as it may have penetrated the cranial cavity, the orbit, or a sinus cavity.12,13 Other indications to consult an Otolaryngologist include failure of the Emergency Physician to remove the foreign body after repeated attempts, failure to properly sedate the patient, or the inability to sedate the patient. All of these contraindications may require foreign body removal in the Operating Room under more controlled circumstances and with equipment not available in the Emergency Department.

Nasal Anesthesia and Vasoconstriction

• 1% or 2% lidocaine solution
• 4% lidocaine solution with 0.25% phenylephrine
• 4% cocaine
• 0.25% phenylephrine (Neosynephrine)
• 5 mL syringe or cotton pledgets
• Atomizer device if available

Manual Removal of Foreign Body (Figure 169-1)

• Head light or head mirror, surgical lamp, or overhead light
• Nasal speculum
• Alligator forceps
• Hartman forceps
• Bayonet forceps
• Frazier suction catheter
• Ear curette
• Blunt mastoid hook
• Wire loop

Catheter Removal of a Foreign Body

• Fogarty vascular catheter, size #4 or #5
• Foley catheter, 5 to 6 French
• 5 mL syringe
• Katz Oto-Rhino Extractor (InHealth Technologies, Carpinteria, CA)

Positive Pressure

• Cooperative parent
• Bag-valve device
• Face mask, various sizes
• Male-male tube adapter

Cyanoacrylate Glue

• Cyanoacrylate tissue/wound glue or “superglue”
• Paper clip or cotton-tipped applicator
• Superglue removal equipment (Chapter 165)

Nasal Wash

• Bulb syringe
• Normal saline

Pediatric Immobilization

• Sheets
• Commercial immobilization device (e.g., Papoose board)

Discuss the risks, benefits, complications, and different techniques available with the patient and/or their representative. Include the possibility of using procedural sedation initially or if initial attempts at removal are unsuccessful. Obtain consent for the removal procedure and the procedural sedation. The type, shape, size, and location of the foreign body are important factors to consider in choosing the most appropriate technique. The patient's age, ability to cooperate during the examination and removal, and the experience and skill of the Emergency Physician can influence the choice of techniques.

The Emergency Physician should observe universal precautions, especially eye protection, while working in close proximity to the mucous secretions in the airway. It is recommended to wear a gown, gloves, and a face mask with an eye shield or goggles. Both nasal cavities should be carefully inspected for foreign bodies before and after the mucosa is decongested. A child will sometimes insert foreign bodies up both nostrils. A good light source is indispensable for examining the nasal cavity and removing the foreign body.

Preparation is important to ensure that the first attempt at retrieval is successful. A variety of equipment should be readily available at the bedside in the event that additional attempts and techniques are required. A Frasier suction catheter should be available to clear the nasal passages of blood and/or mucous. A good light source, particularly a hands-free device (i.e., overhead light source or a head lamp) is important in directly visualizing the foreign body and facilitating its removal.

Anesthesia of the nasal mucosa is obtained by the topical application of lidocaine (maximum 4 mg/kg) or cocaine (maximum 3 mg/kg). Cocaine has the added benefit of vasoconstriction and decongestion of the nasal mucosa. If lidocaine is used, a vasoconstrictive agent such as epinephrine or phenylephrine should be added. A syringe can be used as a dropper to apply the medication intranasally. This is best done by administering several drops at a time and then reassessing visibility before adding more. If the entire dose is added at one time, the child is more apt to blow the medication out their nose before it can take effect. An atomizer device may also be used. Commonly available are devices that attach to a syringe (e.g., Mucosal Atomizer Device, Wolfe-Tory Medical Inc., Salt Lake City, UT) or a nasal decongestant container. Allow 5 to 10 minutes for the medication to take effect.

If the patient is cooperative, it would be appropriate to have them attempt to blow the foreign body out of their nostril. Have the patient sit up and lean forward. Have the patient blow forcefully through their nose while covering the uninvolved nostril with a finger. Even if this has failed at home, it may work with the nasal mucosa swelling alleviated by the decongestants.9

Most children will need to be restrained while the foreign body is being removed. Even the child who appears cooperative and is adequately anesthetized may move suddenly while instruments are in the nasal cavity. One method is for the child to sit on their parent's lap (Figure 169-2). The adult should cross their legs over the child's legs, using one arm to restrain the child's arms and trunk and the other arm to hold the child's forehead (Figure 169-2). Alternatively, instruct an assistant to hold the patient's head while the parent controls the body and limbs. Another alternative is to wrap the child in a sheet or use a commercial restrain device (e.g., papoose board).9

Severely uncooperative patients may require sedation, procedural sedation, or general anesthesia prior to removal of the foreign body. Procedural sedation may be used to facilitate removal, especially in the uncooperative or fearful patient. In one study, approximately 21% of pediatric patients with nasal foreign bodies required procedural sedation.4 The nasal foreign body was successfully removed in 95% of these cases. Ketamine was the most commonly used agent.

Direct Instrumentation or Manual Removal

The most straightforward and common method is to remove the anteriorly located nasal foreign body under direct vision. Instrument removal should not be attempted if the foreign body is located posteriorly. The instruments most often used include alligator forceps, bayonet forceps, straight forceps, or mosquito forceps. Hooked probes, such as right angles or curved hooks, ear curettes, wire loops, or mastoid hooks can also be utilized. In the absence of these, a paper clip can be fashioned into a hook. A novel device is the Lighted Forceps for Foreign Body Removal (Bionix Medical Technologies, Toledo, OH). It is a single patient use and disposable device that contains a light source and acts like a forceps (Figure 169-3).

The EasiEar Disposable Comfort Curette (Splash Medical Devices LLC, Atlanta, GA) is an improvement to the standard disposable plastic curette (Figure 169-4). It is a stainless steel, single patient use, and disposable curette. The rounded wire head is smooth. It lacks the jagged and sharp plastic edges that are often found on molded plastic curettes. The EasiEar has no abrasive edges, seams, or surfaces to potentially abrade the nasal mucosa. This design may prevent abrasions, lacerations, and procedure-related bleeding. The spring wire shaft provides some flexibility and enhanced maneuverability when compared to molded plastic curettes, making the foreign body removal process easier. The angled head and flexible shaft allow it to be manipulated within the nasal cavity to remove a foreign body.

These instruments enable the Emergency Physician to grasp the foreign body directly or pull it out from behind. Anterior located foreign bodies are often easily removed with instrumentation. Forceps are better suited for soft and irregularly shaped foreign bodies (Figure 169-5).5,14 Curettes and hooks are more effective for hard and spherical foreign bodies.5,14 Relative contraindications to instrumentation include posterior located foreign bodies, friable foreign bodies, and smooth or round foreign bodies. Potential complications include posterior displacement of the foreign body leading to nasal obstruction or even aspiration, mucosal abrasions and lacerations, and epistaxis.

Insert the nasal speculum to hold the nostril open. Adjust the headlight or head mirror to illuminate the nasal cavity. It cannot be overemphasized how crucial adequate light and visibility are to successfully remove the foreign body. Remove any mucus or blood with the Frazier suction catheter. Grasp an irregularly shaped foreign body with a type of forceps. Forceps may cause a round or smooth foreign body to slip farther posteriorly when the jaws close. In these cases, pass a curette, wire loop, or mastoid hook behind the foreign body and pull it out (Figure 169-6).9 If the foreign body is a bead and the opening is facing outward, the jaws of a small alligator forceps can be passed through the opening (Figure 169-7). Open the jaws when they are beyond the lumen of the bead and pull the bead from the nasal cavity.

Balloon Catheter Extraction

Some Emergency Physicians prefer to use a catheter with a balloon to pull foreign bodies from the nasal cavity. This technique has a reported success rate of 90%, and is used most successfully for foreign bodies that are round, smooth, and cannot be grasped readily.15 A balloon catheter does not work if the foreign body fully obstructs the nasal passage. Authors describe using a variety of catheters. This includes a #4 to 8 Fogarty vascular catheter, a #6 Fogarty biliary catheter, and a 5 to 6 French Foley balloon catheter.3,9,16 Suction is relatively contraindicated if the foreign body is shaped so that the suction device cannot form a seal or if the foreign body is friable.

Inflate the balloon to ensure it has no leaks. Deflate the balloon. Lubricate the catheter. Insert the catheter until the balloon is beyond the foreign body. The catheter may be placed either above or below the foreign body.9 Inflate the balloon with 2 to 3 mL of air. Gently pull the catheter. The balloon will push the foreign body out of the nostril. A balloon catheter can also be used to stabilize a foreign body from behind while it is removed with a forceps.

The disadvantage to this method is that it is more traumatic and epistaxis is more common.2 If the catheter is not passed under direct vision or if it is too large to pass around the foreign body, the Emergency Physician risks pushing the foreign body posteriorly and impacting it, obstructing the nasal passage, or dislodging it into the airway.

Katz Extractor

The Katz Extractor Oto-Rhino Foreign Body Remover (InHealth Technologies, Carpinteria, CA) is a device designed to extract foreign bodies from the nasal and auditory passages (Figure 169-8). It is a disposable single-use device consisting of a balloon-tipped catheter attached to a syringe. Always test the device before using it. Push the plunger to inflate the balloon and inspect it for any air leaks. Release the plunger to deflate the balloon.

Grasp the device with the dominant hand (Figure 169-9). Gently insert the catheter along the wall of the nasal activity until the balloon is just past the foreign body (Figure 169-9A). Inflate the balloon by depressing the plunger on the syringe (Figure 169-9B). Withdraw the catheter and foreign body from the nasal cavity while maintaining the balloon in the inflated state (Figure 169-9C). If the foreign body has a central hole (e.g., candy or bead), insert the catheter through the hole, rather than behind it, and inflate the balloon.

Hognose Otoscope Tip

The Hognose (IQDr. Incorporated, Manitou Springs, CO) is a disposable, latex free, and single-use device that attaches to a standard otoscope (Figure 169-10). It comes in three sizes (3, 4, and 5 mm), each with a color-coded tip. The size represents the cup size at the tip of the device. The tip is soft, self-molding, and looks like the nose of a hog. It has an insufflation port and suction tubing attached to its side. The adapter on the suction tubing attaches to standard wall suction tubing.

Attach the Hognose to the otoscope similar to attaching a disposable speculum to an otoscope. Turn on the otoscope light source. Attach the hognose tubing to suction tubing and a suction source. Turn the suction source on to low or medium. Grasp the otoscope with the dominant hand. Insert the Hognose into the nasal cavity while visualizing the foreign body through the otoscope head. When the tip of the Hognose is just next to the foreign body, place an index finger over the insufflation port to engage the suction at the device tip. Gently advance the otoscope until the tip of the Hognose is against and attached to the foreign body. If you suddenly see black through the otoscope, the soft tip has collapsed on itself. Remove the finger over the insufflation port and reapproach the object. While maintaining suction, withdraw the Hognose with the foreign body attached.

Gatornose Otoscope Tip

The Gatornose (IQDr. Incorporated, Manitou Springs, CO) is a disposable, latex free, and single-use device that attaches to a standard otoscope (Figure 169-11). It twists onto an otoscope like a speculum. It comes with three different jaw types that attach to the body of the device. These jaws are small flat jaws, large flat jaws, and open loop jaws. A trigger on the body of the device controls jaw opening and closing.

Attach the Gatornose to the otoscope similar to attaching a disposable speculum to an otoscope. Turn on the otoscope light source. Grasp the otoscope with your dominant hand. Insert the ring finger into the trigger. Pull the trigger to close the Gatornose jaws. Gently insert the Gatornose jaws just into the nasal cavity. Push the trigger to open the Gatornose jaws and be able to view through the otoscope. Gently advance the otoscope while visualizing the foreign body through the otoscope head. Position the jaws above and below or anterior and posterior to the foreign body. Pull the trigger to close the jaws onto the foreign body. Withdraw the otoscope with the foreign body in the jaws of the Gatornose.

Suction Technique

Frazier suction catheters are most useful with small or round foreign bodies. Otherwise, this technique will be unsuccessful or will push the object farther into the nasal cavity. This technique is best reserved for large, round foreign bodies where suction can be maintained between the device and the foreign body. Complications include trauma to the surrounding tissues and epistaxis.17

Attach the Frazier suction catheter to the suction tubing. Turn on the suction source to at least 100 mmHg. Gently insert the catheter into the nasal cavity. Place a thumb over the hole in the catheter handle to direct the suction through the tip of the catheter. Gently advance the suction catheter until the tip is in contact with the foreign body. Withdraw the Frazier suction catheter and foreign body from the nasal cavity.

For impacted smooth, spherical objects, suction with plastic intravenous tubing can be used.18,19 Cut a short length of plastic intravenous tubing and attach one end to the suction source. Fashion the other end into a small flange shape using a heat source and any metal object with a rounded end, such as the tip of a hemostat or larger clamp. Heat the jaws of the hemostat and insert them into the plastic tubing just enough to create a flange. Turn on the suction source. Place a hemostat onto the tubing to temporarily clamp the suction tubing. Gently advance the flange tip into the nasal cavity until it contacts the foreign body, taking care not to push it inward. Remove the hemostat from the tubing to activate the suction. Gently but quickly remove the tubing and attached foreign body from the nasal cavity.

Positive Pressure

This technique is best utilized for foreign bodies that are large, posteriorly located, or occlude the nasal passage. It involves the generation of positive pressure in the nasopharynx behind the foreign body to force it out of the nostril. There are several ways to generate positive pressure within the nasal cavity. One is to simply ask the patient to occlude the unaffected nostril, take a deep breath through their mouth, close their mouth, and then forcefully exhale the air out through the nostril with the foreign body while keeping their mouth closed. This technique is most successful in older children and adults who are cooperative and can coordinate the movements. The advantage to this technique, if it is successful, is that no instruments are placed into the nose. The disadvantage is that the foreign body becomes a flying body. Eye protection is advised.

Other variants of this technique have been developed. The “big kiss,” also known as the “parent's kiss” or “mouth-to-mouth” technique, involves asking the parent to blow into the child's mouth.20 This is similar to rescue breaths during cardiopulmonary resuscitation (CPR). Explain the procedure to the child and the parent. Instruct the parent to open the child's mouth with one hand and stabilize the chin while occluding the unaffected nostril with a finger from their other hand. Instruct the parent to open their mouth, take a big breath, and then place their mouth over the child's open mouth. The child's mouth must be completely covered by their parents and a good seal formed. Instruct the parent to deliver a sudden and forceful breath into the child's mouth. This entire sequence of events should only take 3 to 4 seconds to complete.

This maneuver causes the child's glottis to close. If enough pressure is generated, the foreign body will be expelled from the affected nostril. This technique may be less traumatic to the child and involves no instrumentation or restraint.20 High success rates have been reported.21 However, this technique may be difficult for some parents to perform. A modified version of this technique involves using a drinking straw or small tube between the child's mouth and parent's mouths. The parent then gives a big puff of air through the straw while the child tries to make a tight seal between their mouth and the straw. This technique can also be performed by the Emergency Physician without placing their mouth on the child's mouth.

A bag-valve-mask device (i.e., the Ambu-bag) can also be used to blow the foreign body out the nostril.22 Choose a face mask that is small enough so that it only covers the patient's open mouth. Cover the patient's mouth tightly with the mask. Close the unobstructed nostril with a finger (Figure 169-12). Squeeze the bag to force air into the mouth, lungs, and out the nose.22 A variant of this method uses an anesthesia bag connected to high-flow oxygen (10 to 15 L/min). Cover the mouth with the mask, close the thumb hole, and allow the bag to expand and gradually increase the airway pressure. If this does not expel the foreign body, compress the bag.3

The “Beamsley Blaster” technique makes use of the positive pressure generated from the application of high flow (10 to 15 L/min) oxygen from tubing attached to an oxygen wall outlet.23 The other end of the tubing is attached to a male-male adapter, which is then inserted into the unaffected nostril. The set-up generates enough pressure in the posterior nasopharynx to dislodge the foreign body from the nostril. The patient's mouth must be closed during the procedure to create a seal. Although there were no complications noted in the initial study, a subsequent case of barotrauma (subcutaneous orbital emphysema) was recently reported.24

If an SMR cabinet or other blower with a nasal tip is available, place the nasal tip in the unobstructed nasal cavity. This method is contraindicated if there are foreign bodies in both nasal passages. It is important to be sure that the nasal tip is placed in the open nasal cavity or the foreign body could be blown into the trachea or esophagus. Blow short puffs of air during the child's cries. The soft palate will close when the child is vocalizing and direct both the air and the foreign body out the other nostril.2

Cyanoacrylate Glue—Assisted Removal

Cyanoacrylate glue can be used to extract spherical and other solid foreign bodies that are visible.25 However, this technique can be fraught with complication. There is a chance of gluing the foreign body to the nasal mucosa as well as creating a glue foreign body. The foreign body can be further impacted if pushed posteriorly or fall into the oropharynx and aspirated.

Obtain a long, thin object (e.g., straightened paper clip or the stick end of a cotton-tipped applicator). Moisten the tip of the paper clip or applicator stick with a very tiny amount of cyanoacrylate glue. A larger amount can drop off into the nasal cavity. Insert the paper clip or applicator stick before the glue dries and until it just touches the foreign body. Maintain this position for 30 to 60 seconds to allow bonding of the glue to the foreign body. Do not allow the drop of glue to fall from the stick, as it will bond to the nasal mucosa. Do not touch the tip of the wooden applicator stick to the nasal mucosa, as it will bond to the mucosa. Remove the paper clip or applicator stick with the foreign body attached. The main disadvantages of this technique are potential bonding of the nasal mucosa and the time it takes for the glue to bond to the foreign body.

Nasal Wash

The nasal wash technique involves the introduction at high pressure normal saline through a bulb syringe into the unaffected nasal cavity. Place approximately 7 mL of normal saline into a bulb syringe. Insert the bulb syringe into the unaffected nostril. Advance it into the nostril until a seal is created. Forcefully squeeze the bulb syringe. The pressure generated is believed to expel the saline and the foreign body from the other nostril. The use of this technique carries a high risk of aspiration of saline and the foreign body, as well as concerns about reflux of the saline into the sinuses or eustachian tubes.26 This technique should not be used in patients with a button battery or organic matter in their nasal passages. The increased moisture will hasten corrosion of the battery and cause swelling of the organic matter, making additional attempts at removal more difficult. This technique should also not be used in young infants and those with airway or neurologic abnormalities.

Magnet Removal

An occasional patient will present with a mini-magnet adhered to the nasal mucosa. The source of the magnets can be from their insertion in young children or nasal jewelry in older children, adolescents, and adults.10 Adherence of magnets across the nasal septum creates the potential for septal necrosis and perforation.11,27,28 They may be difficult to remove because of the attractive force they create across the nasal septum.

Numerous methods can be used to facilitate magnet removal. They may be grasped with a variety of forceps or hemostats. A hook can be made from nonferromagnetic blunt probe.10 A magnet can be used to facilitate nasal magnet removal.11,29,30 A pacemaker magnet is readily available in most Emergency Departments. A small and strong pocket magnet may also be available from the hospital maintenance department.

Inspect the nasal cavity for any remaining fragments of the foreign body, ulcerations, bleeding, or a second foreign body. A gray precipitate may be noted if a disk battery has been removed. After a battery is removed, the nasal cavity should be irrigated with saline to remove any electrolyte solution or precipitate to prevent further damage.12 Bleeding can be controlled with topical phenylephrine or epinephrine, pressure, or any of the methods described to control epistaxis (Chapter 172).

The patient can be discharged home with nasal saline spray to the affected nostril until secretions are clear of blood or pus. Oral antibiotics may be prescribed if the patient has developed sinusitis from a retained foreign body. Patients with ulcerations on opposing sides of the nasal cavity must be followed up to prevent obstructive synechiae or adhesions from forming. Patients with button batteries, mini-magnets in their nasal passages, or other injuries or complications should follow up with an Otolaryngologist. The caretakers should be educated to remove any small objects from the child's reach, supervise children when they have access to small objects, and childproof the house.

Complications can arise from the nasal foreign body itself or the removal technique. Foreign bodies can cause nasal obstruction, epistaxis, pressure on surrounding tissues, infection, ulceration, perforation, or aspiration.5 The risk of complications increases the longer the foreign body is present. Otitis media, sinusitis, facial and orbital cellulitis, epiglottitis, and meningitis have been associated with retained nasal foreign bodies.5,8

The most significant complication would be to dislodge the foreign body into the airway. This is most likely to occur in an uncontrolled situation. Placing the patient supine and in the Trendelenburg position may prevent accidental aspiration of the foreign body.31 Consider the use of sedation, procedural sedation, or general anesthesia if the patient is uncooperative.

Potential complications associated with each technique were described with each specific technique. Aspiration from posterior dislodgment of a nasal foreign body remains a serious potential complication for all the techniques described. Positive pressure techniques can result in barotrauma. Periorbital emphysema has been described in the “Beamsley Blaster” method.24 Secondary infection may also result from the procedure. In most cases, once the foreign body has been removed antibiotics are generally not indicated. Complications related to manipulation within the nasal cavity include bleeding or subsequent infection. In rare instances, an anterior nasal pack may be required to tamponade bleeding. Toxic doses of cocaine and/or lidocaine may result in cardiac arrhythmias and seizures.

The vast majority of nasal foreign bodies can be safely removed by the Emergency Physician with instruments that are readily available in the Emergency Department. There are multiple techniques for removing foreign bodies from the nasal cavity. Each has its own advantages and disadvantages. These methods include the use of forceps, balloon catheters, and positive pressure. The Emergency Physician should choose a method according to the shape and location of the foreign body, the tools available, the cooperativeness of the patient, and their experience with the different removal techniques.