Nasal foreign body

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.
  • Exception: if suspect nasal FB but don't see one, consider radiography to rule out button battery or magnets across septum prior to discharge and follow-up with ENT

Methods

• Consider afrin spray or atomized lidocaine with epinephrine prior to removal efforts.

1. "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
2. 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
3. Alligator forceps or Bayonet forceps
4. Curette
5. Dermabond on end of long q-tip
6. 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

• Foreign body

References

• Harwood-Nuss, Roberts and Hedges