Clinical Hack: Kissing Trick for Nasal Foreign Body Removal

Whenever I notice a toddler has checked into the emergency department waiting room for some sort of foreign body situation, a feeling of dread sends shivers throughout my body. Attempting to remove french fries from the noses of wiggling kids and beads from the ears of screaming infants has never been my forte. Performing procedures on children, especially those involving foreign body removal, just isn’t part of my job that I enjoy. Fortunately, there are a few tricks that make removing foreign bodies a bit easier.

There are many ways to remove a pesky foreign body from a child’s nose. Using hemostats, alligator forceps, or specialized ENT instruments is appropriate in many situations. In others, suction may be effective. But, in my experience in the emergency department, one trick has proven easier and less traumatic than the rest. I’m referring to the kissing technique or, if you prefer to be technical, the use of positive-pressure.

Large nasal foreign bodies, especially those made of a hard, smooth material such as a bead, are amenable to the kissing trick. To perform the kissing method of removing a nasal foreign body, lay the child on the exam table in the supine position. Have a parent (or you) occlude the unaffected nostril with a finger. Then, have the parent place their mouth over the child’s entire mouth forming a seal. The parent should then exhale forcefully into the child’s mouth. The air will force the foreign body from the nostril. Studies show this method is effective in removing nasal foreign bodies in nearly 50 percent of cases.

In my experience, parents usually need to attempt forcefully blowing into the child’s mouth a few times before the foreign body is expelled (talk of the time and cost of transferring to another facility for higher level of care often prompts increased effort on part of the parent). Having a family member or another provider hold and stabilize the child’s head also helps.

If the parent feels uncomfortable participating in the kissing method, you can attempt the trick using a bag-valve mask. Occlude the unaffected nostril, form a seal around the child’s mouth with the mask, and squeeze the bag. In my experience this method is less effective than having the parent blow directly into the child’s mouth.

This video demonstrates the technique using a bag valve mask.