Nose

Nasal Foreign Body

search

Nasal Foreign Body, Nose Foreign Body, Nostril Foreign Body

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