Nasal Foreign Body

    NextPrevious

    Nasal Foreign Body

    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
    • Suction
      • 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

    Read more:

    • UpToDate
    • Reichman, Eric F. Emergency medicine procedures. McGraw Hill Professional, 2013.
    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • renal handling of water

      If you were on a tea & toast diet, how much water would you need to drink before you develop hyponatremia? I haven’t seen anyone work out the numbers before so here are my calculations. AndRead more

    • acute acidemia physiology

      As alluded to in the first post, don’t be fooled by a “normal” potassium in the setting of DKA because osmotic diuresis and H+/K+ exchange means that total body potassium is actually LOW. You all knowRead more

    • renal handling of potassium

      the first symptom of hyperkalemia is death Earlier post covered temporizing measures to counter hyperkalemia — namely, intracellular shift, increasing cardiac myocyte threshold potential. Give furosemide if the patient still urinates and consider dialysis, but then askRead more

    • bicarbonate revisited

      Previous post reviewed the safety of balanced crystalloids in hyper K. But what was up with serum bicarbonate decreasing with saline administration? This post introduces a new way of looking at the anion gap to possiblyRead more

    • hyperkalemia and balanced crystalloids

      Is it safe to give LR or plasmalyte to a hyperkalemic patient (these balanced crystalloids have 4-5 mEq/L K as opposed to 0 mEq/L K in normal saline)? Postponing the discussion of renal handling of potassium toRead more

    • hyperkalemia physiology

      You’ll likely encounter hyperkalemia on your next Resus / Cardiac shift, and you’ll instinctively treat it. But take a moment to review the fascinating physiology behind the “cocktail”! First, consider how K+ is buffered byRead more

    • Slow down your tachycardia (but not really)

      You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate wasRead more

    • Otitis externa: use the ear wick!

      Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear”Read more

    NextPrevious