ear, nose, and throat disorders
How To Remove a Foreign Body From the Nose
Step by Step Description of Nasal Foreign Body Removal
Have the patient gently blow the nose to remove mucus and perhaps the foreign body. If the nose is dripping, suction the nasal passageway carefully to remove mucus without pushing the foreign body further posterior. Apply a topical anesthetic and vasoconstrictor to reduce sensitivity and mucosal swelling. Wait 3 to 5 minutes to allow the anesthetic and vasoconstrictor to take effect. If there is still significant edema, apply a second treatment of topical vasoconstrictor. Insert a nasal speculum with your index finger resting against the patient's nose or cheek and the handle parallel to the floor (so the blades open vertically). Slowly open the speculum and examine the nose using a bright headlamp or head mirror, which leaves one hand free to manipulate suction or an instrument. Use a Frazier-tip suction catheter to remove any mucus obscuring the view. For certain soft objects and hard objects with a graspable edge located anteriorly, grasp and remove the object using forceps (eg, alligator or bayonet forceps). Remove harder or larger objects located anteriorly by placing a wire loop or hook curette behind the object and gently pulling. Remove smooth, round objects using a suction catheter; place the suction tip against the object with the finger control open. Then cover the finger control to apply suction and gently remove the object. Remove objects not amenable to an anterior approach with a balloon-tipped catheter (eg, an 8 French urinary catheter). Insert the lubricated deflated balloon behind the object. Be careful not to push the object further into the nasal passage. Slowly inflate the balloon with air—about 2 mL in small children, 3 mL in older children, and 5 mL in adults. Slowly withdraw the balloon, pulling the object forward until resistance is met, then remove the object. Deflate the balloon and remove it from the nose. 