Nose
Nasal Foreign Body
search
Nasal Foreign Body
, Nose Foreign Body, Nostril Foreign Body
See Also
Ear Canal Foreign Body
Airway Foreign Body
Esophageal Foreign Body
Epidemiology
Common in children and developmentally disabled
Etiology
Inorganic Materials (Beads, Pebbles, Wax, Button batteries)
Organic Materials (Beans, Peas)
Tend to swell and soften
Makes removal more difficult
Signs
Unilateral foul smelling discharge
Nasal obstruction
Vasocon
striction makes foreign body more easily seen
Precautions
Do not push posteriorly (May result in aspiration)
Button batteries and magnets require immediate removal
Risk of Septal perforation, nasal adhesions, saddle deformity
Management
Patient attempts to expell foreign body
Blow nose with opposite nare occluded
Trial of insufflation
Occlude opposite nostril (e.g. with finger)
Parent blows into mouth (or with
Ambu Bag
)
Avoid using excessive pressure or volume
Forces air through nostril with foreign body (glottis typically closes as a reflex)
Management
Clinician attempted removal in clinic or emergency department
Pretreatment
Phenylephrine
0.5% (
Neo-Synephrine
) or
Afrin
Topical Anesthetic
(e.g.
Lidocaine
via Intranasal Mucosal Atomization Device or MAD)
Conscious Sedation
may be required in young or developmentally delayed patients
Exercise
caution with sedation in Nasal Foreign Body (risk of posterior displacement)
Consider deferring sedation and removal to otolaryngology in operating room
Airway protection
Position the patient to reduce risk of posterior foreign body displacement
Procedures and Instruments
See
Ear Foreign Body
for other techniques
Nasal speculum
May increase visibility
Katz Extractor
http://www.inhealth.com/category_s/49.htm
Fogarty or
Foley Catheter
(lubricated 5-6 french catheter)
Insert behind foreign body, inflate balloon and then pull out with foreign body
Avoid forcing the obstruction posteriorly
Forceps (Alligator or bayonet)
Cerumen curette
Management
Referral
Most foreign bodies may be safely deferred to ENT for removal in 1-2 days
Batteries (esp. button batteries) and magnets should be removed emergently (local necrosis risk)
Posterior foreign bodies may risk airway obstruction and may require more urgent removal
Referral Indications
Foreign body refractory to removal attempts (posterior or hidden)
Chronic foreign body with significant localized reaction
Young or developmentally delayed patients requiring
Conscious Sedation
Significant
Trauma
on attempted removal
Sharp, penetrating or hooked foreign body
References
Claudius and Brown (2017) Crit Dec Emerg Med 31(12): 13-20
Claudius, Behar and Stoner in Herbert (2015) EM:Rap 15(11):2-3
Chan (2004) J Emerg Med 26: 441-5 [PubMed]
Heim (2007) Am Fam Physician 76: 1185-9 [PubMed]
Kalan (2000) Postgrad Med J 76: 484-7 [PubMed]
Type your search phrase here