3 Epistaxis Aspiration Incomplete removal of the foreign body Procedure Preparation for the procedure to minimize pain and anxiety and maximize visualization is the key to success The patient must remain still during instrumentation of the nose to prevent injury to the internal nasal structures In most instances, it is useful to apply a topical vasoconstrictor (neosynephrine 0.25% or oxymetazoline 0.05%) to constrict the nasal vasculature A few drops of lidocaine with epinephrine may provide mucosal anesthesia as well as vasoconstriction The child should be supine and restrained Visualize the interior of the nose with a nasal speculum and a headlight or directed light source, as shown in Figure 130.21A Purulent secretions should be gently removed with the use of a Frazier suction tip until the foreign body is visualized Extract the object with suction, a hook, or alligator forceps as determined by the size, nature, and position of the object In some instances, procedural sedation may be necessary to facilitate the removal of the foreign body Figure 130.21B shows a hook being placed beyond a round foreign body Do not push the foreign body into the posterior nasopharynx because it may be aspirated by the struggling child The use of irrigation is not recommended because the foreign body may slip posteriorly and be aspirated, and hygroscopic foreign bodies (e.g., sponges) may swell, increasing the difficulty of removal The use of cyanoacrylate has been effective but requires the glue to directly contact the foreign body for up to 30 seconds against a wooden stick; contact with the mucosa can result in adherence of the stick to the nasal mucosa rather than the foreign body Katz Extractor or Foley Catheter Directly visualize the foreign body utilizing a nasal speculum if necessary Advance the deflated balloon of the Katz extractor or Foley catheter just beyond the foreign body Once the deflated balloon is beyond the foreign body, inflate the balloon and slowly withdraw with the balloon inflated from the nose The foreign body will be drawn out of the nasal cavity by the inflated balloon