Nasopharyngeal Foreign Body following a Blind Finger Sweep

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A healthy 9-month-old girl playing with her father’s cufflink suddenly developed respiratory distress, coughing, and inconsolable crying. The child’s mother attempted to search her mouth using a blind finger sweep. She felt an object and had the impression that the child had swallowed it.

On arrival at the emergency department, the child was uncooperative, agitated, and crying, but had no signs of respiratory distress. The respiratory examination was normal, and inspection of the oral cavity and nasal fossae was inconclusive. A chest X-ray showed no signs of air-trapping and no evidence of the cufflink (Figure, A). Based on clinical suspicion, an additional radiography of the upper airways was performed, and this confirmed the presence of the cufflink in the child’s nasopharynx (Figure, B). Endoscopic extraction was successfully performed by an ear, nose, and throat specialist with the child under general anesthesia.

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• Figure. 

  A, Inspirium and expirium X-rays of the chest. B, Lateral X-ray view of the upper airways showing a nasopharyngeal foreign body.

This case illustrates the danger of using a blind finger sweep to remove oropharyngeal objects in children. This potentially fatal maneuver¹ frequently induces traumatic epiglottitis², ³, ⁴, ⁵ and may advance the foreign object into the respiratory airways, causing airway obstruction and choking. The case also reinforces that in children with a suspected respiratory foreign body, X-rays of the entire airway are essential to locating the foreign body and making the correct diagnosis.

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Thanks to Alan Gervaix, MD, for his assistance with the clinical management of this patient.

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References 

1. Abder-Rahman HA. Infant choking following blind finger sweep. J Pediatr (Rio J). 2009;85:273–275
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2. Hartrey R, Bingham RM. Pharyngeal trauma as a result of blind finger sweep in the choking child. J Accid Emerg Med. 1995;12:52–54
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3. Gjoni D, Mbamalu D, Banerjee A, James K. An unusual complication of an attempt to open the airway in a choking child. Br J Hosp Med (Lond). 2009;70:595
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4. Yen K, Flanary V, Estel C, Farber N, Hennes H. Traumatic epiglottitis. Pediatr Emerg Care. 2003;19:27–28
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5. Deutsch ES. Traumatic supraglottitis. Int J Pediatr Otorhinolaryngol. 2004;64:851–854
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