Safety and Efficacy of a Protocol for In-Office Pediatric Nasal Foreign Body Removal.

OBJECTIVES

To examine the success and limitations of office removal of nasal foreign bodies (FBs) in a pediatric population.

METHODS

Children presenting to an academic pediatric outpatient department were identified from a computerized collection of office notes. FB removal was performed via: (1) preprocedure discussion with shared decision-making, (2) topical anesthesia and vasoconstriction of the nose, (3) restraint in supine position with a trained second person holding the head, and (4) FB removal using an operative microscope with instrumentation. Removal was considered a failure if subsequent removal under general anesthesia was required.

RESULTS

Among 547 consecutive children presenting with head and neck FBs during a 22 year period, exactly 100 had nasal FBs. Forty-four percent had previous attempts at FB removal in an emergency department or pediatricians' office. Ninety-six percent of FBs were successfully extracted in the office. Four percent required removal in the operating room. No complications were reported. Children with neurodevelopmental disorders were no more likely to experience failed removal ([0/4] vs [6/96], P = .61). The most common FBs were beads (19%), plastic (12%), and foam rubber (10%).Concluearsion:This protocol resulted in a high rate of successful nasal FB removal, even in children with prior failed attempts with no significant nasal injuries. This approach should be considered by otolaryngologists who care for children.

LEVEL OF EVIDENCE: 3 - retrospective review.