Nasal foreign body: Difference between revisions
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==Background== | ==Background== | ||
*Common foreign bodies (FB) include food (beans, nuts, gum), marbles, batteries, beads, magnets, jewelry, stones, tissue, etc. | *Common foreign bodies (FB) include food (beans, nuts, gum), marbles, batteries, beads, magnets, jewelry, stones, tissue, etc. | ||
*Suspect foreign body in a patient with ''unilateral'' purulent or bloody nasal discharge or unilateral sinusitis even if no history of FB insertion. | *Suspect foreign body in a patient with ''unilateral'' purulent or bloody nasal discharge or unilateral sinusitis even if no history of FB insertion. | ||
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*Radiographic imaging unlikely to be helpful. | *Radiographic imaging unlikely to be helpful. | ||
==Methods== | ==Methods== | ||
*Consider afrin spray or atomized lidocaine with epinephrine prior to removal efforts. | *Consider afrin spray or atomized lidocaine with epinephrine prior to removal efforts. | ||
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#Balloon catheter (e.g. foley catheter or fogarty catheter) - snake catheter into nare past the foreign body → gently inflate balloon → gently pull catheter out of nare | #Balloon catheter (e.g. foley catheter or fogarty catheter) - snake catheter into nare past the foreign body → gently inflate balloon → gently pull catheter out of nare | ||
==Complications== | ==Complications== | ||
*Tympanic membrane barotrauma from "Parent's Kiss" or BVM technique | *Tympanic membrane barotrauma from "Parent's Kiss" or BVM technique | ||
*Bleeding | *Bleeding | ||
Revision as of 16:33, 8 July 2016
Background
- Common foreign bodies (FB) include food (beans, nuts, gum), marbles, batteries, beads, magnets, jewelry, stones, tissue, etc.
- Suspect foreign body in a patient with unilateral purulent or bloody nasal discharge or unilateral sinusitis even if no history of FB insertion.
- Small children may need Procedural Sedation (Peds) for removal efforts.
- Radiographic imaging unlikely to be helpful.
Methods
- Consider afrin spray or atomized lidocaine with epinephrine prior to removal efforts.
- "Parent's Kiss" - like performing mouth to mouth. Have parent close contralateral nare, form tight seal over child's mouth. Perform short, sharp blow of air into patient's mouth to expel FB
- BVM technique - similar to "Parent's Kiss" technique - close opposite nare, use BVM with tight fit over mouth only, squeeze bag to provide short, sharp blow of air
- Alligator forceps or Bayonet forceps
- Curette
- Dermabond on end of long q-tip
- Balloon catheter (e.g. foley catheter or fogarty catheter) - snake catheter into nare past the foreign body → gently inflate balloon → gently pull catheter out of nare
Complications
- Tympanic membrane barotrauma from "Parent's Kiss" or BVM technique
- Bleeding
- Displacement of foreign body into airway
- Tissue necrosis (batteries and magnets)
Disposition
- Most patients can be discharged
- If unable to remove FB, or if complications → refer to ENT
- If foreign body is button battery or multiple magnets (esp strong rare earth magnets), requires immediate removal in ED. Consult ENT if needed.
See Also
References
- Harwood-Nuss, Roberts and Hedges