Removal of NFB
NFB can be removed by various means, including exertion of positive
oronasal pressure18 and the use of various medical
instruments, such as suction, forceps, hooks and a Fogarty
catheter19. Kadish et al.20previously published successful NFB extraction rates of 98% among
pediatricians. Removal failure was defined in our study as an attempt to
extract the NFB, which ultimately required further intervention (by a
second physician, usually an otolaryngologist, or by general
anesthesia). All 26 patients who required anesthesia were examined
primarily by an otolaryngologist (either as a first or a second
attempt). Altogether, 69% of the patients were seen by
otolaryngologists. The failure rate among otolaryngologists was 6.7%.
Pediatricians in the ED treated 172 children without referral to an
otolaryngologist. The failure rate among pediatricians was 24%
(p=0.01). Nonetheless, complicated NFB (28 patients, 5%) were always
seen by otolaryngologists; this demonstrates proper clinical assessment
and referral by ED pediatricians. X-ray radiographs were rarely (1%)
used in our cohort.