The Case

A 3-year-old female presents to the emergency department after placing a small bead into her left nostril. The bead became lodged, and the child is unable to move any air out of the left naris. All efforts to remove the foreign body prior to arrival have failed. The child is currently cooperative but apprehensive. Is there a minimally invasive way to safely, quickly, and easily remove or dislodge the foreign body?

Background

Children often present to the ED with foreign bodies lodged in their nares, with various explanations as to how they got there. On occasion, parents will have given a valiant effort to remove the object prior to arrival in the ED, usually without success. While some of the techniques attempted are more successful than others, there is one such method that may, in fact, straddle the line between anecdotal and evidence based. The Parent’s Kiss is a technique that has been perpetuated by social media and word of mouth as a way for parents to attempt removal before presenting to the ED. With this method, parents or guardians place their mouth over the child’s mouth while at the same time occluding the child’s nonoccluded nostril. They then blow forcefully into the child’s mouth in hopes of dislodging the nasal foreign body.

The question is, does this technique have any merit?

Looking at the evidence, it seems that it might. As it turns out, the use of positive pressure techniques for removal of nasal foreign bodies is not a novel concept. In 2002, Navitsky et al were the first to report the use of high-flow oxygen to remove a nasal foreign body. The technique, referred to as the Beamsley Blaster, is well-described and uses oxygen tubing with a male-male adapter to deliver positive pressure.¹ While the technique shown above is similar, it differs slightly in that suction tubing, which usually comes with a prepackaged adapter, is utilized, but the end result is the same.

The Technique

Use wall oxygen or medical air (positive pressure technique) to dislodge a unilateral nasal foreign body with the use of standard suction tubing and a suction adapter.

While there are several ways to attempt removal, using high-flow oxygen or medical air in the contralateral nostril delivered through suction tubing is a safe alternative to more traditional techniques and utilizes equipment easily found in every emergency department. This technique allows for a quick, clean, and painless way to dislodge a nasal foreign body with a high rate of success.