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 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 FB

Methods

  • Consider afrin spray or atomized lidocaine with epinephrine prior to removal efforts.
  • Keep patient upright to avoid FB 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
  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 (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 FB or extensive edema increases risk of sinusitis

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.
  • Short course prophylactic antibiotics if FB was present for a long time or there is edema - risk of sinusitis

See Also

References

  • Harwood-Nuss, Roberts and Hedges