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 sedation (consider PO benzo, ketamine)
• consider afrin spray and/or lido with epi prior to attempting removal

Methods

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 pt's mouth to expel FB
2. BVM technique: similar to parent technique, close opposite nare, use BVM with tight fit over mouth, squeeze bag
3. alligator forceps or bayonet forceps
4. curette
5. dermabond on end of long q-tip
6. balloon catheter: foley catheter or fogarty catheter: snake catheter into nare behind object, fill balloon, pull object out

Complications

• tympanic membrane barotrauma from "parent's kiss" technique
• bleeding
• displacement of foreign body into airway
• retained FB will need to be seen by ENT
• magnets and batteries will require removal ASAP to prevent tissue necrosis

Sources

Harwood-Nuss, Roberts and Hedges