Foreign body insertion in the nose in paediatrics is a common presentation to the ED.
It is more common in children less than 7 years or those with intellectual impairment.
Most patients present on the day of insertion but occasionally this may be delayed for days/weeks and can present as an offensive nasal discharge or may be discovered incidentally on routine examination.
Types of foreign body
A large variety of objects have been implicated. These include beads, plastic toys, vegetation and food.
The most serious retained FB is the button battery that can cause mucosal damage and necrosis.
Children with nasal foreign bodies tend to be younger than other ENT foreign bodies.
Admission by child
Sensation of swelling
Foreign body is usually seen on direct vision
Usually none indicated
Accurate identification of foreign body is essential prior to removal to guide removal technique
Ensure good lighting preferably with headlight
A cooperative or restrained patient is necessary and this may require sedation techniques See ED Guideline Procedural Sedation
Nasal co phenylocaine may be used to reduce swelling and may help in expulsion of the foreign body.
Forced air using air viva and occlusion of opposite nostril
Suction – may be used but requires a smooth spherical object provide a good seal
Forceps – can grasp some objects but often will slip on rounded objects and push the object further in
Hook – insert along medial wall of nostril with hook pointing cranially and then pass hook behind the object and rotate hook laterally to bring hook behind object and withdraw object
Glue on a stick
ENT referral for fibroptic endoscopy
Complications of removal
Routine nursing care.
Isaacson GC, Aderonke O (2014) Diagnosis and Management of Intranasal Foreign Bodies. UpToDate. Accessed at www.uptodate.com