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Editor,—We read with great interest the review of foreign bodies in the nasal cavities compiled by Kalan and Tariq in a recent issue.1 The authors state that there are no comprehensive discussions on the subject of foreign bodies in the nose, but appear to have overlooked previous reviews by Werman2and Baker,3 perhaps because their methodology lacks a systematic approach. Furthermore, we feel that the article affords undue emphasis to the role of the ear, nose, and throat (ENT) surgeon, and the requirement for their early involvement in this condition.
Emergency physicians frequently encounter foreign bodies in the nose, often in children brought to the hospital by their parents soon after insertion. In this group the presentation is not an offensive unilateral nasal discharge, as stated by Kalan and Tariq, but a history of recent insertion with local irritation. We have published a systematic review of foreign bodies in the nose and ear, including techniques for their removal in the emergency department.4Current evidence indicates that the vast majority can be removed without complications by suitably trained emergency department staff, and without the need for ENT involvement. Locally we have been able to demonstrate considerable success with an appropriate teaching programme and a specific set of instruments for foreign body extraction.
It seems likely that Kalan and Tariq's article is biased by the fact that only difficult, complex, or late presenting cases tend to be referred to an ENT surgeon. We wish to emphasise the important role that emergency physicians have in this common condition.
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