Nearly half of pediatric patients referred for nasal foreign body removal had already undergone at least one unsuccessful extraction attempt before evaluation by an otolaryngologist, according to a recent study.
A 22-year retrospective review reported a 96% success rate using a standardized pediatric nasal foreign body (FB) removal protocol. Only 4% of pediatric patients required removal under general anesthesia, despite 44% having experienced at least one prior failed extraction attempt in another clinical setting.
Researchers reviewed 547 consecutive pediatric head and neck FB cases managed between 2001 and 2023 and identified 100 patients with nasal FBs. Using a retrospective review of office notes and operative reports, the researchers assessed the safety and efficacy of a consistent in-office removal protocol. Removal was classified as unsuccessful only if subsequent management under general anesthesia was required.
The protocol incorporated preprocedure counseling and shared decision-making with caregivers, followed by topical anesthesia and vasoconstriction using 2% lidocaine combined with oxymetazoline. Pediatric patients were positioned supine and briefly restrained using a papoose or parental assistance, with continuous head stabilization provided by a trained nurse or medical assistant. All procedures were performed under direct binocular visualization with an operating microscope, which enabled bimanual instrumentation and improved depth perception. Instrument selection was based on FB characteristics and included right-angle hooks for smooth spherical objects, forceps for irregular items, and suction for friable materials. Positive-pressure techniques and balloon catheters were not used.
Of the 100 pediatric patients with nasal FBs, 96 underwent successful office-based removal. "Our consecutive series demonstrates that with our standardized protocol involving proper restraint, topical anesthesia and vasoconstriction, head stabilization, and direct microscopic visualization, 96% of nasal [foreign bodies] could be safely removed in the office without sedation," stated lead author Dilan Prasad, BS, of the Department of Otolaryngology – Head & Neck Surgery and the Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, and colleagues. Four patients required operative removal because of impacted or posteriorly located FBs or inability to tolerate nasal manipulation
No major complications, including septal perforation, retained FBs, or significant infection, were reported. Beads were the most common FBs, accounting for 19% of cases, followed by plastic objects at 12% and foam rubber at 10%. The mean age of patients with successful removal was 3.7 years, and outcomes did not differ by age or sex. Pediatric patients with neurodevelopmental disorders did not have higher rates of unsuccessful removal compared with other patients.
The researchers noted several limitations, including the retrospective design and reliance on keyword searches, which may have missed cases or underreported minor complications. The single-surgeon setting may limit generalizability, and the absence of a control group prevents determination of which protocol components most strongly influenced success.
The researchers reported no conflicts of interest.
Source: Ear, Nose & Throat Journal