Balloon Tip Catheter Technique for Nasal Foreign Body Removal
The balloon tip catheter (BTC) technique involves inserting a deflated Foley or similar balloon-tipped catheter past the foreign body, inflating the balloon behind the object, and then withdrawing the catheter to extract the foreign body anteriorly under direct visualization. 1, 2, 3
Procedural Steps
Pre-Procedure Preparation
- Perform nasal endoscopy to identify the exact location of the foreign body before attempting removal, as this allows visualization in 87-93% of cases and prevents complications 1
- Apply topical vasoconstrictor (such as oxymetazoline) to reduce mucosal edema and improve visualization 1
- Ensure adequate lighting and have suction readily available 2
BTC Removal Technique
- Insert the deflated balloon-tipped catheter gently past the foreign body using direct visualization with a nasal speculum or endoscope 2, 3
- Inflate the balloon with 2-3 mL of air or saline once positioned posterior to the object 3
- Apply steady, gentle anterior traction to withdraw the catheter and foreign body together 2, 3
- Maintain visualization throughout the procedure to prevent posterior displacement into the nasopharynx 2
Critical Safety Considerations
Contraindications and Warnings
- Never perform blind removal attempts or finger sweeps, as these can push the foreign body posteriorly and cause aspiration 1
- Button batteries and magnets require emergent removal due to risk of septal perforation or necrosis within hours 2
- Avoid excessive force during catheter insertion or withdrawal to prevent mucosal trauma and epistaxis 4
Alternative Equipment Considerations
- Suction devices, modified paper clips, and cotton swabs have lower epistaxis rates compared to forceps (p < 0.05), making them beneficial alternatives when appropriate 4
- The BTC technique is particularly useful for smooth, round objects (beads, plastic toys) that are difficult to grasp with forceps 3
- Multiple techniques should be available, as a significant number of patients require more than one removal attempt 5, 3
Post-Removal Management
Immediate Assessment
- Re-examine the nasal cavity with endoscopy after removal to ensure no residual foreign material remains 1
- Apply topical vasoconstrictors or perform nasal cautery if bleeding occurs from the removal site 1
Timing Considerations
- Epistaxis incidence is significantly higher when foreign bodies remain for ≥1 day versus same-day removal (p < 0.05), emphasizing the importance of prompt removal 4
- Delayed diagnosis can result in nasal infection, sinusitis, septal perforation, or synechiae formation 1
When to Refer
- Consult otolaryngology for foreign bodies adjacent to critical structures, deeply embedded objects, or failed removal attempts 1, 5
- Refer cases where there is concern for unrecognized pathology or when adequate visualization cannot be achieved 1
- Consider specialist referral for uncooperative patients requiring sedation or general anesthesia 2