Removal of intranasal hairpin at the bedside: Two adult cases

INTRODUCTION Foreign bodies are commonly encountered where a natural body orifice may be found. Urologic foreign bodies are well described in the literature, with examples that include a plethora of intravesical and urethral patientinserted objects. Complicated foreign body removal from the nose or nasopharynx is a common responsibility left to the otolaryngologist, often to prevent serious complications including airway compromise and injury to the skull base. National studies of emergency department visits report nearly 200,000 visits for nasal foreign bodies alone over a 5-year period, with a median patient age of 3 years. Because of their predominance in children, intranasal foreign bodies are commonly small, hard objects that may be removed at bedside, such as beads, round batteries, coins, pills, eraser caps, and buttons—among other objects—although 5% to 10% may require the aid of an endoscope under general anesthesia. By contrast, intranasal foreign bodies in adults often have unusual presentations, commonly involving trauma, and have involved objects such as teeth, twigs, and small fish. Because of their atypical presentation, foreign bodies in adults have often been managed endoscopically under general anesthesia. When clinically appropriate and safe, however, removal at bedside should be the preferred method; it involves decreased morbidity and monetary expense relative to the operating room. Here, we present two independent cases of adults who presented with large hairpins lodged in the nasal cavity that were successfully removed at bedside. Traditionally called bobby pins, the modern metal hairpin was invented by Samuel Tick under US patent 2489598A, with two major improvements upon the prior model. The first improvement was to apply soft rubber caps (Fig. 1, D) to either end of the pin in order to prevent damage to women’s dental enamel when they used their teeth to open the pin, as was commonly done. The second improvement was to prevent the pin from slipping in the hair by extending the distal rubber coating at least one centimeter toward the Ushaped proximal end (Fig. 1, A), and to bend the distal portion of one leg in a shallow V-shape (Fig. 1, C) such that the apex meets the other leg and produces tension when the two legs are separated. To our knowledge, the cases presented here are the first reported instances of removal of intranasal hairpins, which due to their characteristic design require precise maneuvers for successful removal.