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.