Nasal Foreign Bodies – Positive Pressure Technique

We have all been there… whether at work at home… looking at a child in disbelief: “why would you put that up there?” Inevitably, what goes up, must come down. But how?

There are various instruments, all fun to use and scary for a child to see near his or her face.

One technique which is often over-looked and under-valued is the “positive-pressure technique” or “kissing technique.”

• It has been demonstrated to be efficacious and has the advantage of not employing long hooks, foley-type devices, glue, or suction.
• It is easy to do, less scary for the patient, and can be done even at home… a bonus if your own kids, or neighbors’ kids like to put things in places they don’t belong.
• ts success rate has been demonstrated to be around 50%, which is excellent… ½ of the patients get less trauma and you get less nasal discharge on you.

Personally I bring a Katz Extractor (small foley-type device) in with me, but keep it out of sight.

Then explain the “kissing technique: to the parent:

• Have the child blow his/her nose (not usually successful given the age group you are usually dealing with.
• Then the Parent (not you… another bonus) places his or her mouth over the child’s while the unaffected nostril is occluded.
• The parent exhales into the child’s mouth and 50% of the time, the foreign body will shoot out (along with snot). {It is nice to have a tissue ready for the parent- helps with service excellence scores.}

If it doesn’t work, plans B-Z can be entertained. But if it works, you’ve just saved the child, the family and you a lot of time and trouble!

It is a great method to remember when the neighbor calls you also… perhaps you can save them a trip to the ED (not that we wouldn’t welcome them with open arms).

Alleemudder, D, Sonsale, A, Ali, S. Positive pressure technique for removal of nasal foreign bodies. International Journal of Pediatric Otorhinolaryngology, 2007; 21 (11), pp. 1809-1811.

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

Taylor, C. Acheson, J. Coats, T. (2010). Nasal foreign bodies in children: kissing it better. Emergency Medicine Journal.