Common objects include beads, plastic toy parts, corn kernels, and beans. Techniques for removal include grasping the object with forceps, dragging the object out using a hook or curette, and direct suctioning. Prior to any instrumentation, vasoconstriction of the mucosa and topical anesthesia should be used. Familiarity with and use of headlamps ease diagnosis and treatment, free the physician’s hands, allow the physician use of both hands, and provide binocular vision and better lighting—all of which facilitate the retrieval of the object. Proper placement of the nasal speculum is critical for patient comfort and maximal visualization.

• Trick of the trade: Lighting is essential to this procedure. If an ENT headlamp is unavailable, a common LED camping headlamp similarly provides adequate lighting, as demonstrated in photo 3. Next, maximize visualization of the foreign body by using a nasal speculum. Hold the speculum vertically to avoid applying pressure on the nasal septum. Rest the handle of the speculum comfortably in the palm of the hand while placing your index finger on the patient’s ala (see photo 5). The Day hook can be used to draw the foreign body forward using the technique described previously. After removal of the object, be sure to re-examine both nares again, because foreign bodies may occur in multiples.

Oropharyngeal Foreign Body

Oropharyngeal foreign bodies are another common problem encountered in the emergency department. Upper-airway foreign bodies can be removed in the emergency department in the awake, cooperative patient without signs of airway compromise. Patients complain of a sensation of “something stuck in their throat.” Optimal visualization is the key, and the emergency physician should be comfortable using a laryngeal mirror. A common problem with these mirrors, however, is fogging during the oropharyngeal exam.

• Trick of the trade: Laryngeal mirror fogging is caused when the warm air from the patient’s breath contacts the cool mirror surface. To minimize this fogging problem, warm the laryngeal mirror to body temperature. This may be done placing the mirror in a bath of warm water prior to use. In addition, chlorhexidine, which can reduce mirror fogging, can be applied to the mirror.

Dr. Colina is an emergency medicine resident at Michigan State University. Dr. Dudek is an otolaryngologist at Sparrow Hospital in Lansing, Mich. Dr. Lin is an associate professor of clinical emergency medicine at the University of California, San Francisco, and practices at San Francisco General Hospital. Contact Dr. Lin at Michelle.Lin@emergency.ucsf.edu with comments or suggestions for other “tricks of the trade.”