Table 2:
Characteristics of the studies included in the systematic review
| Study details; country | Age range; sex ratio | Previous attempt(s) at removal/total | Exact method used | Type of foreign body | Location of foreign body within nasal cavity; time since insertion | Person who performed the technique | Successes/total; no. of attempts using “mother’s kiss” | Adverse effects reported; reduction in use of general anesthesia |
|---|---|---|---|---|---|---|---|---|
| Case series | ||||||||
| Botma et al., 1 prospective case series (19 patients); UK | 1–5 yr, 12M:7F | 10/19 | Parent makes firm seal over child’s open mouth and gives short, sharp puff of air into mouth while occluding unaffected nostril | Vegetable matter, sponge, bead, button, pebble, tissue paper, magnet | All objects visible on anterior rhinoscopy; 1 hr– 2 wk | Parent | 15/19; vegetable matter (6/6), sponge (3/4), bead (2/3), button (1/2), pebble (2/2), tissue paper (1/1), magnet (0/1); not specified | None; not reported |
| Purohit et al.,12 prospective case series (31 patients); UK | < 5 yr, (mean age 33 mo, median 24 mo), 19M:12F | 14/31 | Parent’s kiss (parent makes firm seal around child’s partially open mouth, and delivers a short, sharp puff of air, while occluding the unobstructed nostril with a thumb; repeated max. 5 times) | 17 small, smooth, spherical objects (e.g., peas, beads), 13 large, irregular objects (e.g., paper, plastic)* | Object not visible in 4 cases, 2 of which were removed by parent’s kiss; other 2 became visible after parent’s kiss, allowing removal with hook; 30 min–7 d | Parent | 20/31 (removal aided by mother’s kiss in 2 other cases); (13/17 small smooth spherical objects; 7/13 large irregular objects); not specified (up to 5 attempts) | None; rate reduced from 32.5% to 3.2% over 6-mo period after technique introduced |
| Backlin,13 retrospective case series (8 patients); Canada | 2–4 yr; 3M:5F | Not specified | Topical vasoconstrictor applied if edema or bleeding; child positioned supine; caregiver gives a puff of “mouth-to-mouth” while occluding the unobstructed nostril with a finger | Beads (2), sunflower seed, plastic doll shoe, styrofoam chip, plastic toy piece, popcorn kernel, crayon piece | Location not specified; time unknown for 1 case, all others brought immediately to hospital | Caregiver | 8/8; not specified | None; not reported |
| Wagner,14 retrospective case series (2 patients); Denmark | 1.5 and 2.5 yr; 2M:0F | 2/2 | The parents are instructed in the method; they tell the child that he or she is to have a huge kiss in which air will be blown into the mouth; the parent closes his or her lips around the open mouth of the child (e.g., “mouth-to- mouth resuscitation”; the unaffected nostril is obstructed by a parent’s finger; swift vigorous pressure is applied while kissing, and the FB is blown out; the procedure may be repeated several times before success; after, the doctor ensures that the FB is out) | Piece of wiener sausage, small stone | Right posterior naris, other not specified; time since insertion not specified | Parent | 2/2 (stone removed after 3 attempts); not specified | None; not reported |
| Taylor et al.,15 retrospective case series (84 patients); UK | 1–8 yr (median 2 yr); 31M:53F | Not specified | Done by the parent under instruction from a trained member of staff; the parent puts his or her mouth over the child’s (giving a “big kiss”) and occludes the unaffected nostril with 1 finger; the parent then exhales into the child’s mouth, generating positive pressures, similar to that of nose blowing | Food (18), toys (47), materials (17), not documented (2) | Left nostril (30), rightnostril (53), bilateral (1), exact location not specified; time not specified, but average time spent in ED 67.7 min | Parent | 41/84; not specified | None; use of anesthesia lower when compared with cases in which the technique was not attempted (11.9% v. 18.8%) |
| Alleemudder et al.,16 case series (8 patients); UK | 2–7 yr; 4M:4F | Not specified | Positive pressure technique, fully explained to parent before procedure; child told that a “big kiss” would be given; child held sitting semi- recumbent; parent applies finger pressure on ala of unaffected nostril to occlude it;, parent blows air forcibly into child’s mouth to dislodge FB forward and out of nostril | Toy part, sponge, eraser, pea, plastic beads (2), rubber tire, raisin | Location not specified; time since insertion not specified | Parent | 5/8; 1–4 attempts | None; not reported |
| Case reports | ||||||||
| Hore,17 case report (letter); UK | 3 yr; 1F | 0/1 | Parent’s kiss as described by Backlin13 (child lies on back and opens mouth; unaffected nostril occluded with finger, firm seal made around child’s mouth by parent’s mouth and short puff of air delivered into child’s mouth to expel the FB) | Small polystyrene bead | Object just visible in right nostril; time not specified, but attempt made soon after insertion | Father | 1/1; not specified | None; not specified |
| Manca,18 description of technique and case report; Canada | 5 yr; 1F | 0/1 | Parent’s kiss (pressure applied to unaffected nostril, brisk blow into child’s mouth, forcing air out of the affected nostril) | White scented bead | Bead just visible in nostril; time not specified, but attempt made immediately after insertion | Mother | 1/1; not specified | None; not specified |
Note: ED = emergency department, F = female, FB = foreign body, M = male.
*
Discrepancy between number of patients and number of objects successfully removed appears in original study by Purohit et al. Attempts to contact authors of original study for clarification were unsuccessful.