Nasal foreign bodies present with a wide variety of complaints ranging from history of insertion without symptoms (71-88% of patients), mucopurulent nasal discharge (17-24%), foul odor (9%), epistaxis (3-6%) to mouth breathing (2%). Most commonly, foreign bodies are located under the inferior turbinate on the nasal floor or in front of the middle turbinate. Foreign bodies can range from toys and food to the dreaded button battery.
*Two foreign bodies to worry about: button batteries, paired disc magnets (found on some jewelry) both can cause tissue necrosis. These need to come out emergently.
How to diagnose: visualize the foreign body! Most are anterior in the nasal cavity and can be seen using a light source – otoscope, head lamp, +/- nasal speculum. If the FB is more posterior, they might need an endoscope, flexible or rigid.
Methods of Nasal Foreign Body Removal:
- Direct Instrumentation
- Best for FB that do not occlude the entire nostril
- Treat with topical anesthesia and vasoconstrictor prn – topical lidocaine, oxymetazoline before attempted removal
- Small children may need to be burrito wrapped (not a medical term)
- Use right angle hook, alligator or bayonet forceps, attempt removal
- Same setup as above
- Place suction on foreign body, attempt removal
- Positive Pressure aka Mother’s Kiss
- Best for foreign bodies that occlude the whole nostril
- Step 1: Occlude the PATENT nostril (the one without the foreign body)
- Step 2: Parent blows a breath into the child’s mouth
- Step 3: If successful, FB shoots out! **You can replace a parents breath with BVM
- Foley Balloon Technique
- Pretreat prn as above
- Pass foley catheter – between 5-8 French depending on the size of the child PAST the foreign body
- Inflate balloon
- Gently pull
When to consult ENT:
- Impacted or chronic FB that can’t easily be removed
- Penetrating FB
- Posterior location – patients who need an endoscope
- Reichman, Eric F. Emergency medicine procedures. McGraw Hill Professional, 2013.