Why should the nasopharyngeal airway not be used if there is evidence of fluid coming from the nose or ears?

A nasopharyngeal airway is contraindicated in the following situations:

- Evidence of Battle's Sign (bruising behind the ear)

- Severe facial of cranial injuries.

- Signs of cerebro-spinal fluid (CSF) or raccoon eyes.

NB: the clear fluid coming out of the patient's nose or ears is most likely CSF. CSF protects and insulates the brain, and can leak from the skull if there is head trauma.

The above situations indicate the possibility of a traumatic brain injury (previously termed 'head injury'). The risk of the nasopharyngeal airway intruding with the brain is fairly high so as a precaution, an alternative airway is used. An oropharyngeal airway would be a better alternative in a patient with suspected traumatic brain injury.

A nasopharyngeal airway, (aka NPA or a nasal trumpet), is a tube inserted into the nasal passageway of an unconscious victim to provide an open airway (when unconscious the jaw muscles relax and the tongue to falls back obstructing the airway).

NPA is contraindicated (not used) in patients with severe head or facial injuries, or a basilar skull fracture (Battle's sign, raccoon eyes, cerebrospinal fluid/blood from ears, etc.) due to the possibility of direct contact with brain tissue.