Foreign bodies in the ear or the nose can be extremely challenging to remove, especially considering that a majority of them occur in children less than 7 years old who are likely to be uncooperative with exam [1]. In a previous post, we emphasized the need to pick the best tool for the job in order to minimize complications. What happens when you find yourself in an austere environment and the usual tools are not available?

Trick of the Trade: A Improvised Foreign Body Removal Device

Case

A 3-year-old boy presents to a small rural clinic in Monrovia, Liberia with a rock stuck in the right naris. Multiple attempts by parents to dislodge the rock failed. The providers came up with a novel approach for removal.

Equipment

  • 10 cc syringe
  • 18-gauge angiocatheter
  • Condom
  • Tape
foreign body

Image 1: Tools required for assembly

Technique

  • Attach syringe to 18-gauge angiocatheter and place condom over top with the reservoir tip over the top of the angiocatheter.
  • Use tape to seal the condom to the angiocatheter
  • Test for balloon insufflation at the tip
  • Cover with lubrication gel and insert into affected naris past lodged object
  • Insufflate the balloon and apply gentle traction to the whole device in order to pull the object out.

This method is similar to the technique used to remove esophageal foreign bodies using foley catheters [2]. While this technique should not be a first line approach, this case report illustrates it is an effective method to remove nasal foreign bodies when other methods are not available.

 

foreign body

Image 2: Proud provider demonstrating the device in action

Dealing with a ear or nasal foreign body in a resource rich setting? Make sure you pick the right tool: PEM Pearls: Search & Rescue of Ear Foreign Bodies.

References

  1. Ansley J, Cunningham M. Treatment of aural foreign bodies in children. Pediatrics. 1998;101(4 Pt 1):638-641. PMID: 9521948
  2. Dunlap LB. Removal of an esophageal foreign body using a Foley catheter. Ann Emerg Med. 1981 Feb;10(2):101-3. PMID: 7224249
Louis Yu, MD

Louis Yu, MD

Resident
Department of Emergency Medicine
University of California, San Francisco
Louis Yu, MD

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Josh Bukowski, MD

Josh Bukowski, MD

Attending
Captain, USAF, MC
SAMMC Department of Emergency Medicine
JBSA Fort Sam Houston
Josh Bukowski, MD

@DocBukowski

Emergency Medicine Resident at University of California San Francisco Captain United States Air Force