Foreign body in the nose

Notes

## Basic introduction

  • Foreign body (FB) in the nose is common in preschool children where it usually happens out of curiosity
  • It can also affect both psychiatric and mentally challenged patients
  • FBs in the nose are classified into two categories: inanimate FBs and animate FBs

## Inanimate FBs include some of the following:

  • Beads
  • Seeds
  • Buttons
  • Sweets
  • Crayons
  • Beans
  • Peas
  • Nuts
  • Button batteries (can cause chemical burns)

## Animate FBs include some of the following:

  • Worms
  • Maggots
Symptoms
  • Visible FB
  • Persistent discharge from one nostril
  • History of obstruction of one nostril
  • Nose bleeding
  • Excoriation of nasal vestibular skin

## Possible consequences of the presence of FBs in the nose

  • Infection
  • Inflammation
  • Granulation of tissue
  • Ulceration of mucus
  • Necrosis of bone or cartilage
  • Formation of rhinoliths (which are mineralized FBs in the nasal cavity that can grow and can cause a foul-smelling nasal discharge and breathing challenges)
Diagnosis
  • Clinical review
  • Nasal endoscopy
  • X-ray may be useful, especially if the suspected FB is radio opaque
  • Non-contrast computed tomography (NCCT) and Para Nasal Sinus (PNS) scan
Differential
  • Nasal infection
  • Sinusitis (unilateral)
  • Choanal atresia (unilateral)
  • Nosebleeds
  • Neoplasms
Prevention
  • keep the child in the environment that is free of objects that can be inserted in nostrils
  • Teaching children to avoid placing foreign objects into their noses.
Reference

a. Thomas SH, Goodloe JM. Foreign bodies. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 60. 

b. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf

Management
  • Failed attempt to remove the FB may push it into the pharynx - which is a medical emergency!
  • The First-Aid measure that includes blowing the air sharply through the mouth (by the mother or by use of bag mask or ambu bag) while blocking the unaffected nostril. This is the Positive Ventilation Technique.

   OR

  • Pressing and closing the nostril that is not affected by FB and asking the person to blow the nose gently

   OR

  • If the FB remains, apply local anesthetic with a nasal decongestant drops (to minimize the swelling of the nostril) to prepare the nostril for the removal of FB
  • Attempt to remove the FB with a nasal speculum and a hook or thin forceps
  • In case of maggots:

_Administer a broad spectrum antibiotics

_Place cotton pledgets that have been soaked in 25% chloroform and turpentine oil (4:1) in the nostril and remove the maggots manually

## Refer to the ENT specialist in case of:

  • Persistent discharge from one nostril
  • In case of uncooperative patient (who may need sedation)
  • Where the FB is in the posterior location of nostril
  • When tumour or mass is suspected
  • When rhinoliths are detected.
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