Removal of Foreign Bodies from

the Ear and Nose

TO THE EDITOR
In the Video in Clinical Medicine “Removal of Foreign Bodies from the Ear and
Nose” (Feb. 18 issue),1 the author shows the use of a papoose board — a
technique that requires placing the child in a restraining device and forcefully
holding the child’s head still. A child so restrained typically attempts to free
himself or herself from restraint while crying in distress. In the past quarter
century, in developed nations, forceful restraint of children for minor procedures
has been largely supplanted by safe and effective procedural
sedation.2,3 Restraint is emotionally disturbing for the child and his or her
parents and can lead to apprehension about medical personnel and future
medical treatment.

Baruch S. Krauss, M.D.

Boston Children’s Hospital, Boston, MA
baruch.krauss@childrens.harvard.edu

Steven M. Green, M.D.

Loma Linda University, Loma Linda, CA

No potential conflict of interest relevant to this letter was reported.

3 References

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RESPONSE
The author replies: This video emphasizes the need for the patient to be
motionless for removal of a foreign body. An experienced operator can perform
this ultrashort procedure in the clinic without physical or emotional trauma
when the patient is motionless. The video states that, when available, a child life
specialist can help establish rapport and avoid the need for drug-induced
sedation. However, some cases do require sedation or general anesthesia.
I recognize the pioneering efforts of Krauss and Green in establishing safe
pediatric procedural sedation services, which rely on “presedation assessment,
continuous monitoring during the procedure, and recovery scoring systems,” as
well as two trained personnel to oversee each procedure.1,2 Unfortunately, the
availability of skilled personnel and age-appropriate monitoring equipment is
often limited outside of emergency centers. This video is intended for those who
work in an array of clinical settings. I agree with Krauss and Green that
individualized decisions on the appropriate method to achieve patient
immobility require consideration of the child’s developmental age, previous
experiences with medical care, and the available resources.

Ellen M. Friedman, M.D.

Texas Children’s Hospital, Houston, TX

Since publication of her article, the author reports no further potential conflict of
interest.
2 References