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 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 foreign body insertion.
*Small children may need [[Procedural Sedation (Peds)]] for removal efforts.
*Small children may need [[Procedural Sedation (Peds)]] for removal efforts.
*Radiographic imaging unlikely to be helpful.
*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
**Exception: if suspect nasal foreign body but do not see one, consider radiography to rule out button battery or magnets across septum prior to discharge and follow-up with ENT
*Always check other nare and ears - may have multiple foreign bodies


==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.
 
*Keep patient upright to avoid foreign body going back into airway
#"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
**Can sit on parent's lap with parent hugging / restraining arms
#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
**Can use a c-collar to prevent side to side motion
#Alligator forceps or Bayonet forceps  
*Options:
#Curette (lighted may be helpful)
*#"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 foreign body (best for foreign bodies occluding the whole nostril)
#Dermabond on end of long q-tip
*#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
##Use a disposable speculum to shield the nares so you don't accidentally glue the q-tip to the skin  
*#Alligator forceps or Bayonet forceps  
#Balloon catheter (e.g. foley catheter or fogarty catheter or commercial Katz extractor) - snake catheter into nare past the foreign body → gently inflate balloon → gently pull catheter out of nare
*#Curette (lighted may be helpful)
#Suction (can make own with small caliber ETT cut short or 14 Fr suction catheter cut short)
*#Dermabond on end of long q-tip (Can use a disposable speculum to shield the nares so you do not accidentally glue the q-tip to the skin)
*#Balloon catheter (e.g. foley catheter or fogarty catheter or commercial Katz extractor) - snake catheter into nare past the foreign body → gently inflate balloon → gently pull catheter out of nare
*#Suction (can make own with small caliber ETT cut short or 14 Fr suction catheter cut short)


==Complications==
==Complications==
*Tympanic membrane barotrauma from "Parent's Kiss" or BVM technique  
*Barotrauma from "Parent's Kiss" or [[BVM]] technique  
*Bleeding
*Bleeding or other nasal trauma
*Displacement of foreign body into airway  
*Displacement of foreign body into airway
*Dermabond method: gluing swab to skin
*Tissue necrosis (batteries and magnets)
*Tissue necrosis (batteries and magnets)
*Prolonged foreign body or extensive edema increases risk of [[sinusitis]]


==Disposition==
==Disposition==
*Most patients can be discharged
*Most patients can be discharged
*If unable to remove FB, or if complications → refer to ENT
*If unable to remove foreign body, 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.
*If foreign body is button battery or multiple magnets (especially strong rare earth magnets), requires immediate removal in ED. Consult ENT if needed.
*Short course prophylactic antibiotics if foreign body was present for a long time or there is edema - risk of sinusitis


==See Also==
==See Also==

Revision as of 01:52, 17 May 2019

Background

  • Common foreign bodies 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 foreign body insertion.
  • Small children may need Procedural Sedation (Peds) for removal efforts.
  • Radiographic imaging unlikely to be helpful.
    • Exception: if suspect nasal foreign body but do not see one, consider radiography to rule out button battery or magnets across septum prior to discharge and follow-up with ENT
  • Always check other nare and ears - may have multiple foreign bodies

Methods

  • Consider afrin spray or atomized lidocaine with epinephrine prior to removal efforts.
  • Keep patient upright to avoid foreign body going back into airway
    • Can sit on parent's lap with parent hugging / restraining arms
    • Can use a c-collar to prevent side to side motion
  • Options:
    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 foreign body (best for foreign bodies occluding the whole nostril)
    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 (lighted may be helpful)
    5. Dermabond on end of long q-tip (Can use a disposable speculum to shield the nares so you do not accidentally glue the q-tip to the skin)
    6. Balloon catheter (e.g. foley catheter or fogarty catheter or commercial Katz extractor) - snake catheter into nare past the foreign body → gently inflate balloon → gently pull catheter out of nare
    7. Suction (can make own with small caliber ETT cut short or 14 Fr suction catheter cut short)

Complications

  • Barotrauma from "Parent's Kiss" or BVM technique
  • Bleeding or other nasal trauma
  • Displacement of foreign body into airway
  • Dermabond method: gluing swab to skin
  • Tissue necrosis (batteries and magnets)
  • Prolonged foreign body or extensive edema increases risk of sinusitis

Disposition

  • Most patients can be discharged
  • If unable to remove foreign body, or if complications → refer to ENT
  • If foreign body is button battery or multiple magnets (especially strong rare earth magnets), requires immediate removal in ED. Consult ENT if needed.
  • Short course prophylactic antibiotics if foreign body was present for a long time or there is edema - risk of sinusitis

See Also

References

  • Harwood-Nuss, Roberts and Hedges