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
- Consider afrin spray and/or lido with epi prior to attempting removal
Methods
- "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
- 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
Sources
- Harwood-Nuss, Roberts and Hedges