Foreign Body in the Nose

RED FLAGS

• Beware magnetic balls and button batteries

• Suspicion of an inhaled foreign body

Why is it important

A foreign body in a patient’s nose is a theoretical aspiration risk until successfully removed; however, anecdotally the likelihood of this does appear to be low.

Some objects (eg magnets/button batteries) can cause rapid and severe damage to nasal mucosa warranting early removal.

Nasal foreign bodies should be removed as soon as feasible.

When to involve the ENT Registrar

Different teams may have different policies on the urgency of removal and it is always best to check with your registrar if unsure.

In general:

• Soon (working hours): If you are either unable to locate the foreign body or believe a general anaesthetic is required to locate and retrieve the foreign body

• Immediately: If magnet or button battery is present that you have been unable to remove

Who to admit

Any patient where you have been unsuccessful in removing the foreign body to be booked for EUA nose + removal of foreign body on the emergency list in the morning (Discuss with senior – some allow patient to come back in next morning for emergency theatre list removal)

History and examination

Nasal foreign bodies usually affect children or those with learning difficulties or psychiatric illness. Usually patients present having either told their parents that they have placed a foreign body in the nose or it was visualised. A collateral history is particularly important in children.

It is usually painless however symptoms that could be present include:

• Chronically unilateral offensive/blood stained discharge from nose may indicate a chronic foreign body (rhinolith – may be difficult to remove)

• Unilateral vestibulitis

• Occasionally persistent sneeze, headaches or nasal occlusion

  
  

Want to know: Which nostril, what object was if known, how long suspected been present

Examination

Simple elevation of anterior nares usually sufficient to enable visualisation, thudicums can be used but occasionally poorly tolerated by children.

Usual location: Floor of nasal cavity under the inferior turbinate or superiorly anterior to the middle turbinate

If unable to visualise can attempt visualisation with rigid/flexible endoscope. If clear can safely state no foreign body present

If does not tolerate endoscope and unable to visualise with convincing history usual practice is for EUA under GA, however discuss with your registrar prior to booking

Auscultate lungs for any signs of aspiration

REMOVAL Methods

See also Removing Foreign Bodies

• The ‘parent’s kiss’ technique (A&E will usually have advised and attempted this already) where the parent forces air via the mouth while occluding the non affected nostril has variable success.

• Attempts by untrained professionals is usually unsuccessful and can make subsequent attempts more challenging.

• With most young children, only one attempt will usually be tolerated.

• Always ensure you have a good headtorch and are able to visualise the foreign body prior to any attempt.

Equipment that is useful to use:

• Wax hook - if can get behind object, useful for beads

• Tilleys nasal forceps –good for larger items

• Zolner suction – small round items

• Foley catheter – passed and then inflated and passed forwards

• Crocodile forceps – only useful for items with flat end (tilleys usually easier to use with less chance of pushing further into nasal cavity)

References

Kalan A, Tariq M. Foreign bodies in the nasal cavities: a comprehensive review of the aetiology, diagnostic pointers, and therapeutic measures. Postgraduate Medical Journal. 2000;76:484-487. https://pmj.bmj.com/content/76/898/484.citation-tools

Baranowski K, Al Aaraj MS, Sinha V. Nasal Foreign Body. StatPearls. 2021. https://www.ncbi.nlm.nih.gov/books/NBK459279/

Page last reviewed: 1 December 2022