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

Common location of nasal foreign bodies — Common locations of nasal foreign bodies (Courtesy of Javier Ash 2022) ss = sphenoid sinus, st = superior turbinate, mt = middle turbinate, it = inferior turbinate

Foreign body in nose