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Published on: January 17, 2011
Safety and Efficacy of a Protocol for In-Office Pediatric Nasal Foreign Body Removal
Dilan Prasad1,2, Glenn Isaacson1,2
1Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Insights
Office removal of nasal foreign bodies (FBs) in children is highly successful, with 96% of cases resolved without complications. This method is effective even after previous failed removal attempts, offering a safe alternative to surgery.
Area of Science:
- Otolaryngology
- Pediatric Medicine
Background:
- Nasal foreign bodies (FBs) are common in children.
- Previous attempts at FB removal can be challenging.
Purpose of the Study:
- To evaluate the efficacy and limitations of office-based nasal FB removal in pediatric patients.
- To assess the success rate and complication profile of a standardized removal protocol.
Main Methods:
- Retrospective review of 100 pediatric nasal FB cases over 22 years.
- Standardized office removal protocol including shared decision-making, topical anesthesia, restraint, and operative microscopy.
- Failure defined as need for subsequent removal under general anesthesia.
Main Results:
- 96% of nasal FBs were successfully removed in the office setting.
- No complications were reported.
- Children with neurodevelopmental disorders did not have a higher failure rate (P=.61).
- Common FBs included beads, plastic, and foam rubber.
Conclusions:
- The described protocol achieves a high success rate for pediatric nasal FB removal.
- Office-based removal is safe and effective, even in cases with prior failed attempts.
- This approach is recommended for otolaryngologists managing pediatric nasal FBs.
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.
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