Nasal Foreign Body Removal Research Articles

Otolaryngology Simulation Curriculum Development and Evaluation for Medical Education in Rwanda.

This study aimed to assess the feasibility and acceptability of a new low-cost otolaryngology simulation training curriculum for medical students in Rwanda. Given the limited access to hands-on training and equipment in low-middle-income countries, building confidence in performing basic otolaryngology skills is vital for all medical students, especially where all graduates initially serve in primary care before specializing. Preintervention and postintervention assessments of simulation training. Conducted at the University of Global Health Equity in Rwanda. The simulation program comprised 3 primary components: (1) a low-cost, moderate-fidelity model for cricothyrotomy and tracheostomy practice, (2) a low-cost, low-fidelity ear model for foreign body and cerumen removal, and a high-fidelity manikin for practicing, (3) epistaxis management, and (4) nasal foreign body removal. Students underwent pretest and posttest assessments measuring their knowledge, experience, perceived skill, and confidence in performing these procedures. A survey collected feedback on the program. A total of 29 medical students participated in the simulation program, integrated into a 1-week otolaryngology "boot camp" preceding a 3-week clerkship rotation. All models were created using basic, locally available materials, at a total cost of $1.02 for cricothyrotomy and $0.20 for foreign body models. Knowledge and perceived confidence increased for all 3 simulations. All students found the simulations useful, enjoyable, and anticipated using these skills in future training. The study's results demonstrated that the low-cost otolaryngology simulation was well-received and enhanced knowledge, interest, and confidence in performing basic otolaryngology skills across all simulations.

Common Pediatric Otolaryngology Procedures: Ergonomic Considerations.

Background Otolaryngologists in high-volume children's hospitals developed their operating room workflow practices based on the factors of safety, efficiency, and surgeon preference. Recent data show important benefits and potential reduced risks of proper ergonomic positioning for surgeons to prevent injury. These data suggest that the current operating room workflow practices, in addition to prior training, should be monitored and hopefully improved for surgeons' health. Surprisingly, recent studies have suggested the benefits of standing versus sitting on cognitive function. Objective This study reports the workflow norms for seven operating procedures in pediatric otolaryngology. We seek to identify 1) surgeon preferences, 2) when practices become norms, and 3) whether procedure positions are associated with surgeon discomfort or injury. Methods The Otolaryngology Section of the American Academy of Pediatrics was queried employing a 23-question survey. We included demographic information, reasons for preferences, and surgeon-reported pain. We focused on three workflow issues: 1) length of procedures, 2) site selection (operating room bed vs. transport stretcher), and 3) position of the surgeon (sitting vs. standing). Results Sixty-nine American Academy of Pediatrics members completed the survey. The length of the procedure had minimal effect, with 90% sitting for short procedures such as bilateral myringotomy with tubes, myringoplasty, tonsillectomy, and adenoidectomy. All sit for direct laryngoscopy and bronchoscopy. Most stand for the removal of nasal foreign bodies, drainage of neck abscess procedures, and thyroglossal duct cyst excision. Residency training (75%) and personal comfort (81%) were the more frequently cited reasons for preference. Fewer than one in five (16%) reported preexisting neck or back pain, but this doubled (35%) throughouttheir otolaryngology practice. Conditional distributions of pain showed reports of pain were greater for individuals in practice for over 20 years. Conclusions Pediatric otolaryngologists develop their operating room preferences early during residency training. High rates of neck and back pain (35%) may develop during a surgeon's career. We suggest improved understanding of ergonomics in concert with operating room workflow should be considered during otolaryngology residency training since recent data suggest potential benefits of standing on cognitive function.

Characteristics of Nasal Foreign Bodies and Equipment on Complications During Removal Procedures.

The treatment of nasal foreign bodies involves safe and reliable removal. Few reports have investigated the relationship between equipment and the incidence of complications. This retrospective study included 300 patients with nasal foreign bodies (average: 3.28 years, interquartile range: 2-4 years). Patients' background, characteristics of nasal foreign body, equipment to remove the nasal foreign body, and complications were obtained from medical records. Statistical analysis was performed using Pearson's chi-square test for associated factors and the incidence of epistaxis among the complications. Nasal foreign bodies were found and removed in 256 patients. Forceps, hooks, suction, modified paper clips, and cotton swabs were mainly used to remove the nasal foreign bodies. Epistaxis due to the removal procedure was observed in 26 patients. The occurrence of epistaxis differed depending on the equipment (p=0.077) and was less frequent in suction and paper clips than in forceps (p < 0.05 and p=0.077). Epistaxis was not observed when a cotton swab was used. Aspiration and septal perforation were not observed. A statistical relationship was not detected between the hardness of foreign bodies and the occurrence of epistaxis (p=0.251). The incidence of epistaxis was higher in cases nasal foreign bodies remained for 1 day and over than in cases foreign bodies were removed within 1 day (p < 0.05). This study revealed that suction, modified paper clips, and cotton swabs could be beneficial options for minimizing complications in the removal of nasal foreign bodies. 4 Laryngoscope, 133:2553-2557, 2023.

Characteristics of Pediatric Nasal Foreign Body Cases That Required Multiple Removal Procedures: A Single Tertiary Medical Center Cross-Sectional Study.

Removal of nasal foreign bodies in children should be completed as few numbers of times as possible to reduce the burden on the child. This study aimed to reveal the characteristics of pediatric nasal foreign body cases that required multiple removal procedure and to investigate the appropriate removal method for each shape of foreign body. We retrospectively reviewed patients who visited a pediatric emergency department because of nasal foreign body from November 1, 2018, to October 31, 2020. We compared the characteristics of patients, foreign bodies, and treatment between the success and failure groups in the first removal procedure. Moreover, we described the detail of patients in the failure group. We also showed final successful removal methods according to the shape of the foreign bodies. We included 104 children in our analysis. Between the success and failure groups in the first removal procedure, there was no statistically significant difference in the characteristics of patients and foreign bodies but a significant difference in the removal method ( P < 0.001). In the failure groups, the most frequent number of times required for removal is 2 and the most common methods in the first removal procedure was the parent's kiss, most of which were performed on spherical foreign bodies in younger children, Finally, only 7 cases (6.7%) failed to remove the foreign body. According to the shape of the foreign bodies, the percentage of forceps and clamps used for successful removal was high in every shape. There was a significant difference in the removal method between the success and failure groups in the first removal procedure, but finally, most foreign bodies were removed by emergency physicians. Therefore, further research is needed to determine the appropriate removal method for each patient and foreign body.

EP-244 A “missed” nasal button battery in a child during the COVID-19 pandemic

A 5-year-old boy was referred acutely to the on-call ENT doctor following multiple remote consultations with his general practitioner with 2 months history of worsening left-sided foul-smelling nasal discharge and bleeding. He underwent examination under anaesthesia and removal of nasal foreign body which was subsequently identified as a button battery (intra-operative as well as imaging pictures included). This case highlights the challenges posed to clinicians during the COVID-19 pandemic but also serves as a reminder to keep a high index of suspicion and low threshold for clinical examination in suspected cases of nasal foreign body. It also highlights that since COVID19 omicron variant has emerged it is more than significant to evaluate cases that are assessed remotely with increased care to avoid any further misses or mistakes.

A “Missed” Nasal Button Battery in a Child During the COVID-19 Pandemic

A 5-year-old boy was referred acutely to the on-call ENT doctor following multiple remote consultations with his general practitioner with 2 months history of worsening left-sided foul-smelling nasal discharge and bleeding. He underwent examination under anaesthesia and removal of nasal foreign body which was subsequently identified as a button battery. This case highlights the challenges posed to clinicians during the COVID-19 pandemic but also serves as a reminder to keep a high index of suspicion and low threshold for clinical examination in suspected cases of nasal foreign body.

Comparison of pediatric nasal foreign body removal by care setting: A systematic review and meta-analysis

• Foreign bodies of the nose are a common phenomenon in children presenting to a healthcare provider. • Pediatric nasal foreign bodies have a high rate of removal success (>80%) regardless of presentation setting. • Failed attempts at removal by non-Ear Nose Throat specialists significantly decrease the likelihood of removal success. • Improperly treated nasal foreign bodies can require children to be sedated with general anesthesia for removal.

Effectiveness of parents kiss for removal of pediatric nasal foreign bodies

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Lodging of foreign body in the nose is one of the common accidents in pediatric age group leading to emergency consultation. Our aim was to evaluate the efficacy of mouth to mouth blowing to remove or facilitate removal of nasal foreign body.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective interventional study on 46 children aged 2-6 years presenting to pediatric emergency department at Sher- I-Kashmir institute of medical sciences with a history of unilateral foreign body in nose, between February 2016 and January 2019. At the most, three attempts of Mouth-to-mouth blows were given to remove the foreign body. In case of failure, instrumentation was used. The data was tabulated according to age, Gender, type of foreign body and management received.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 46 children, 16 of the children were girls and 30 were boys. Parents kiss was successful in removing nasal foreign body in 34 (79.31%) children. Beads were the most common types of foreign bodies (36.96%). The most common presentation was report of accidental placement of something in the nose, other presentations were bleeding from the nose and unilateral discharge. 22 of 27 (81.48%) ‘Simple’ foreign bodies were removed by parents kiss while 12 of 19 (63.15%) ‘complex’ foreign bodies were removed by parents kiss.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; For children presenting with foreign body in the nose, mouth to mouth blowing should be the first maneuverer to facilitate removal.&lt;/p&gt;

278 Nasal Foreign Body Removal: Success Rates for Techniques and Devices

Nasal foreign bodies (NFB) are a common complaint in the emergency department (ED), especially among young children. The aim of this community-based study was to describe our success rate with various techniques and devices for NFB removal in a large cohort of children presenting to the ED in West Michigan. This is a retrospective cohort analysis of children (age < 19 years) presenting to the EDs of seven affiliated hospitals in West Michigan with a diagnosis of NFB. Spanning 13 counties in Michigan, affiliated institutions included three rural medical centers, three university-affiliated hospitals and a children’s tertiary care facility. All eligible cases were seen between December 2013 and November 2020 (84 months). Patient demographics, type of NFB, treatment in the ED, complications, and final disposition were recorded using a standardized abstract form. Main outcome criteria was the first-attempt success rate of each technique. Descriptive statistics (mean, SD) and 95% confidence intervals (95% CI) were used to describe key demographic and outcome variables. During the study period, 1199 children presented to the ED with a total of 1213 NFBs. Average age was 3.1 +/- 2.2 years; 55.0% were female. Forty-six different types of NFBs were identified, typically located in the right nare (57.9%) for a mean duration of 16.5 hours. Nineteen different extraction techniques were documented during the study period. First-attempt success rates included the nasal balloon extractor (95.5%), alligator or bayonet forceps (82.3%), suction catheters (67.9%), wax loop/curette (63.1%), parent’s “kiss technique” (56.6%) and hemostat (41.9%). Overall, 71.9% (95% CI, 69.3 to 74.4%) of NFB were removed on the first attempt; 19.7% (95% CI, 17.5 to 22.1%) on the second attempt; and 7.0% (95% CI, 5.6 to 8.6%) required three or more attempts. A total of 23 children (2.0%) children required sedation for the procedure. Thirty-six children (3.2%) were referred to ENT; 4 patients were admitted to surgery. Complications occurred in 46 children (4.0%) and included mild epistaxis, swallowed NFB, pain, and posterior displacement of NFB. A large number of simple removal techniques and devices are available for NFBs in children depending on the type of foreign body, location, age of the child, and degree of obstruction. These methods are not time consuming and do not require complex equipment.

Satisfaction with an In-House Nasal Foreign Body Removal Manikin: A Randomized Controlled Trial

IntroductionNasal foreign bodies can lead to life-threatening conditions. Hence, it is a necessity that physicians be well trained in the appropriate procedures for removal of nasal foreign bodies. However, training on real patients is not only unpractical it is also too dangerous, due to risk of foreign body aspiration during the procedure. Therefore, our goal was to construct a manikin, with a specific design, to serve all possible needs for training.MethodsWe developed an in-house manikin from 2 materials; these being flexible polyurethane foam and silicone. Silicone, which has elasticity similar to nasal alae, was used to develop the detachable nose and nasal cavity, whilst polyurethane foam, which is light and easy to carry, was used to develop the head. The in-house manikin was compared with a commercial manikin for satisfaction after a nasal foreign body removal procedure was performed in both groups, by 37 physicians, after conducting a randomized controlled trial with a crossover design.ResultsThe satisfaction scores of the in-house manikin were statistically significantly higher than the satisfaction scores of the commercial manikin for 6 dimensions: proper size, ease of use, ease of maintenance, flexibility of nasal alae relative to actual anatomy, similarity of the nasal cavity relative to actual anatomy and confidence that the manikin can upskill the medical students ability to practice on real patients (p value < 0.05).ConclusionThis in-house nasal foreign body removal manikin design had high satisfaction for training and could be used to develop further nasal foreign body removal manikins in the future.

Nasal Foreign Body Removal by Open Rhinoplasty Approach - An Unusual Case Report

Nasal Foreign Body Removal by Open Rhinoplasty Approach - An Unusual Case Report

Nasal foreign body removal using a magnetic device

Nasal foreign body removal using a magnetic device

Optimum Gate Location in Injection Mold of Nasal Foreign Body Removal Cover

Optimum Gate Location in Injection Mold of Nasal Foreign Body Removal Cover

Simulation Training for Operational Medicine Providers (STOMP): Impact of a Comprehensive Skills-Based Curriculum for Military General Medical Officers.

A standardized training curriculum designed for general medical officers (GMO) titled Simulation Training for Operational Medicine Providers (STOMP) was recently developed to educate and improve GMOs' procedural skills through directed feedback prior to assuming duties in an operational environment. This study aimed to determine the impact this novel curriculum had on GMOs'confidence levels in 21 core privileges covering eight different subspecialties while stationed at Naval Medical Center Portsmouth (NMCP). A cohort study from 2015 to 2017 was designed to address our specific aim to examine if the implementation of the STOMP curriculum increased GMOs' confidence levels. Fifty-seven participants enrolled in the study. The GMO case group completed the STOMP curriculum (n = 22), while the control or GMO self-study group (n = 35) did not complete the curriculum. Six months after starting clinical practice at NMCP, both groups completed an online survey that assessed their confidence level in performing each core privilege using a 5-point Likert scale. Scores were analyzed using a Wilcoxon Mann-Whitney test. Research data were derived from an approved Naval Medical Center, Portsmouth, Virginia IRB, protocol number: NMCP.2016.0010. Participants demonstrated a statistically significant increase in self-rated confidence scores (p < 0.05) in nine core privilege skills: punch biopsy, shave biopsy, excisional biopsy, removal of otic foreign body, removal of nasal foreign body, removal of ocular foreign body, tonometry, incision and drainage of a thrombosed hemorrhoid, and reduction of simple closed fractures and dislocations. These findings suggest that a novel and recently developed standardized simulation training curriculum entitled STOMP improves the confidence levels of early career physicians' in several primary care procedural skills and is an ideal adjunct to traditional lecture-based teaching prior to independent practice in a primary care environment.

Fabrication and verification of three-dimensional prototyped models of nasal cavities and paranasal sinuses

Objective: To make three-dimensional prototyped models of nasal cavities and paranasal sinuses for endoscopic skills training and teaching and to verify and evaluate the fidelity of the models. Methods: Imaging data of a patient with nasal septum deviation was selected for prototyping the nasal cavities model, and the imaging data of a patient with chronic rhinosinusitis who underwent the endoscopic sinus surgery 4 months ago was selected for the paranasal sinuses model. Both patients came from the Department of Rhinology, the First Affiliated Hospital of Zhengzhou University. The models were printed by the desktop-level printer based on the fused deposition modeling (FDM). The evaluations of anatomical structures and prespecified tasks on the simulators were completed by 5 residents and 5 experts of Rhinology.The models were evaluated by survey ratings based on a 5-point Likert scale. The average time to complete each task was calculated.Mann-Whitney nonparametric test was used to assess the differences between experts and residents groups. The statistical significance level was set at P<0.05. Results: All the components of the two models were prototyped in 24 h. For the nasal cavities model, the scores of each anatomical structure were more than 4.0. As to the paranasal sinuses model, except for the frontal sinus (3.6), the scores of each anatomical structure were more than 4.0. All the participants who performed the prespecified tasks evaluated the models well (>4.0). With the nasal cavity simulator, the experts completed the tasks (nasal cavity and nasopharyngeal endoscopy, removal of nasal foreign body, nasal packing, pledget insertion), and the other tasks (the nasal cavity and nasopharyngeal endoscopy, identification of ostiums of paranasal sinuses, maxillary sinus debridement with 70° nasal endoscopy) were completed with paranasal sinus model. The average time to complete each task by experts group and residents group (M (P(25), P(75))) were 10.3 (10.0, 10.7) s vs 17.1 (14.6, 20.7) s, 2.1 (2.0, 2.2) s vs 3.4 (2.6, 4.7) s, 30.1 (27.8, 32.8) s vs 59.2 (52.0, 65.4) s, 54.8 (50.1, 63.2) s vs 92.2 (79.3, 106.9) s, 9.3 (8.7, 9.9) s vs 14.5 (13.3, 14.9) s, 20.1 (19.3, 21.2) s vs 41.9 (35.5, 45.1) s, 31.1 (28.8, 35.2) s vs 52.8 (47.7, 56.3) s, respectively, and the average time to complete each task was shorter for the experts group than for the residents (U value was 0, 1.000, 0, 0, 0, 0, 0, respectively, all P<0.05). Conclusion: The models of nasal cavities and paranasal sinuses made by our desktop-level FDM 3D-printer are useful for endoscopic training skills.

Will children ever learn? Removal of nasal and aural foreign bodies: a study of hospital episode statistics.

Introduction Foreign body removal is a common reason for children to attend the emergency department. Generally, aural and nasal foreign bodies are not associated with immediate morbidity unless they are button batteries. There can be consequences of migration and removal. Methods Hospital Episode Statistics for 2010-2016 were used to calculate the number of nasal and aural foreign bodies that have been removed in hospital. Data for adults and children have been compared. Results 8752 nasal and 17,325 aural foreign bodies have been removed from adults and children over the course of 6 years. Children were responsible for 95% of the 8353 nasal and 85% of the 14,875 aural foreign body presentations. Children aged 1-4 years are most at risk of injury. Conclusion Children are more likely to present to hospital than adults with a foreign body in the ear or nose. Aural bodies were more likely to need removal in hospital for both populations. Authors believe that these require identification and removal by an ear, nose and throat specialist to prevent morbidity. The overall number of procedures performed annually in children has not reduced over the study period; an average of 1218 nasal and 2479 aural foreign body removals are performed each year with an annual cost of £2,880,148 to NHS England.

Noxeno-Research &amp; Development of an Affordable Nasal Foreign Body Removal Device in India

Noxeno-Research &amp; Development of an Affordable Nasal Foreign Body Removal Device in India

The art of removing nasal foreign bodies.

ObjectiveThe removal of nasal foreign bodies (NFBs) can be a difficult task for the inexperienced physician, and the more unsuccessful attempts are made, the more difficult the extraction becomes. We have formulated this simple “four-step” approach to improve success, especially on the first try.MethodsA retrospective review of cases requiring NFB removal, seen by one registrar from 2012 to 2016 at Frankston Hospital, was performed.ResultsFrom 2012 to 2016, 93 patients were referred, of whom 65 were confirmed to have NFBs. In all, 20 patients were first seen by the registrar and had the NFB removed successfully. Another 28 patients were referred to the registrar only after one failed attempt by another medical personnel, and the remaining 17 patients were referred after two failed attempts. All patients had the NFB removed locally in the emergency department using the “four-step” approach, except four patients who had the NFB removed under general anesthesia in the operating theater. Three of the latter had two failed attempts and had refused further attempts, and the fourth patient had developed epistaxis after a failed removal by his general practitioner.ConclusionWhen performed correctly, the “four-step” approach will result in the successful removal of NFBs. Ideally, the removal of NFBs should only be performed by an experienced medical personnel, and any failed first attempt removals must be subsequently managed only by an experienced medical personnel.

Continuous negative airway pressure “CNAP”: Novel nasal foreign body removal

&lt;p class="abstract"&gt;&lt;span lang="EN-IN"&gt;We report on a novel and innovative method used to extricate nasal foreign bodies in infants and young children– a common presentation in pediatric emergency care that can at times have potentially serious consequences. In the case of a three-year-old girl, ‘continuous negative airway pressure (CNAP)’ using a continuous positive airway pressure (CPAP) mask and a domestic vacuum cleaner, a nasal foreign body was removed quickly and effectively in a simple and painless procedure. While more cases are needed to confirm safety and efficacy, the principles underlying this technique could have great potential for future clinical use due to its simplicity and accessibility, particularly when compared to other techniques currently used in the home and in the emergency department.&lt;/span&gt;&lt;/p&gt;

“Visual Hook” for the removal of nasal foreign body – Case report

Abstract We present a case of paediatric nasal foreign body removal using a flexible nasopharyngolaryngoscope, which is used both as an endoscope for visualization and as a hook for the rapid and complete removal of the nasal foreign body (“Visual Hook“).