A modified bag-valve-mask positive-pressure technique for removal of nasal foreign bodies in young children: a retrospective case series from a rural pediatric practice

Sandip M. Kisave

doi:10.18203/2349-3291.ijcp20263262

Authors

Sandip M. Kisave Department of Pediatrics, Mahavir Institute of Medical Sciences, Vikarabad, Telangana, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20263262

Keywords:

Nasal foreign body, Bag-valve-mask, Positive pressure, Children, Pediatric emergency, Rural practice

Abstract

Background: Nasal foreign bodies are common in young children, and their removal can be difficult because of fear, distress, and poor cooperation. Positive-pressure techniques provide a non-instrumental alternative, but conventional approaches may require direct mouth-to-mouth contact.

Methods: This retrospective, single-center chart review included 28 consecutive children aged 1-5 years with clinically diagnosed, anteriorly located nasal foreign bodies treated at a rural pediatric outpatient and emergency setting. A modified bag-valve-mask (BVM) technique was used to deliver a brief, controlled positive-pressure puff through the mouth while the contralateral nostril was occluded. Children were observed for at least 30 minutes.

Results: Successful removal was achieved in 26 of 28 children (92.9%; 95% CI=77.4-98.0%). Among successful cases, 22 of 26 (84.6%; 95% CI=66.5-93.9%) were successful on the first attempt. No major complications were recorded during the procedure or observation period.

Conclusions: In this single-operator, single-center pilot series, the modified BVM technique achieved a high removal rate for anteriorly located nasal foreign bodies using equipment commonly available in rural clinical settings. Larger, multicenter comparative studies with standardized pressure protocols are required before broader clinical adoption.

References

Zavdy O, Viner I, London N, Menzely T, Hod R, Raveh E, Gilony D. Intranasal foreign bodies: a 10-year analysis of a large cohort in a tertiary medical center. Am J Emerg Med. 2021;50:356-9.

Kiger JR, Brenkert TE, Losek JD. Nasal foreign body removal in children. Pediatr Emerg Care. 2008;24(11):785-92.

Kalan A, Tariq M. Foreign bodies in the nasal cavities: a comprehensive review of the etiology, diagnostic pointers, and therapeutic measures. Postgrad Med J. 2000;76(898):484-7.

Chan TC, Ufberg J, Harrigan RA, Vilke GM. Nasal foreign body removal. J Emerg Med. 2004;26(4):441-5.

Purohit N, Ray S, Wilson T, Chawla OP. The parent's kiss: an effective way to remove pediatric nasal foreign bodies. Ann R Coll Surg Engl. 2008;90(5):420-2.

Cook S, Burton M, Glasziou P. Efficacy and safety of the mother's kiss technique: a systematic review of case reports and case series. CMAJ. 2012;184(17):904-12.

Cheah PK, Ahmad R, Ho CV, Lim CC. Oral bag-valve-mask insufflation technique to remove unilateral friable nasal foreign body in emergency department. Malays Fam Physician. 2009;4(2-3):91-3.

Charan J, Biswas T. How to calculate sample size for different study designs in medical research. Indian J Psychol Med. 2013;35(2):121-6.

Alleemudder D, Sonsale A, Ali S. Positive pressure technique for the removal of nasal foreign bodies. Int J Pediatr Otorhinolaryngol. 2007;71(11):1809-11.

de la O-Cavazos M, Ríos-Solís J, Montes-Tapia F, Elizondo-Omaña R, Cantu-Moreno D, Treviño-Garza C, Rodriguez-Balderrama I. A new positive-pressure device for nasal foreign body removal. Pediatr Emerg Care. 2014;30(2):94-6.

Grigg S, Grigg C. Removal of ear, nose, and throat foreign bodies: a review. Aust J Gen Pract. 2018;47(10):682-5.

Hills RW, Brown JC, Brownstein D. Barotrauma: a complication of positive pressure for nasal foreign body removal in a pediatric patient. Ann Emerg Med. 2008;52(6):623-5.

Backlin SA. Positive-pressure technique for nasal foreign body removal in children. Ann Emerg Med. 1995;25(4):554-5.

Cetinkaya EA, Arslan IB, Cukurova I. Nasal foreign bodies in children: types, locations, complications and removal. Int J Pediatr Otorhinolaryngol. 2015;79(11):1881-5.

Hira I, Tofar M, Bayram A, Mehmet Y, Cemil M, İbrahim Ö. Childhood nasal foreign bodies: analysis of 1724 cases. Turk Arch Otorhinolaryngol. 2019;57(4):187-90.