Foreign Body Removal, Nose
Nasal foreign bodies that require removal are relatively common among pediatric patients and may also be seen in adult patients, most often those with psychiatric disease or developmental delay. The patient may present asymptomatically after having been witnessed inserting the item. Alternatively, the patient may have unilateral nasal drainage, foul odor, sneezing, epistaxis, or pain. Patients often deny having placed the foreign body; if the diagnosis is considered, this history should not lower the practitioner’s suspicion.
Any object of appropriate size may be found to have been inserted within the nose. Common items include toy pieces; beads; rocks; paper; and food items such as peas, beans, or nuts.1 Small button batteries are of particular concern, as they may, within hours to days, cause chemical burns, ulceration, and liquefaction necrosis, leading to septal perforation.2, 3
When the patient presents immediately or soon after insertion, the physical examination is typically remarkable only for the presence of the foreign body. The object can be found in any area of the nasal cavity, though objects are most predictably below the inferior turbinate or immediately anterior to the middle turbinate.4 Occasionally, evidence of local trauma may exist with erythema, edema, bleeding, or a combination thereof. After prolonged exposure, an increase in these findings is likely to be observed, as well as the presence of nasal discharge and a foul odor.
Numerous techniques of foreign body removal have a broad range of success rates. The method of choice depends on multiple factors, including the level of patient cooperation, the composition of the foreign material, and the expertise of the practitioner performing the procedure.
Nasal foreign body removal may be attempted by an experienced clinician if the object can likely be extracted.
If doubt exists about the reasonable probability of extraction, an otolaryngologist should be consulted. Repeated attempts at removal may result in increased trauma and potential movement of the item into a less favorable location.
Mechanical removal of a foreign body should not be attempted if the item appears to be out of range for instrumentation.
Removal should not be performed without adequate sedation in an uncooperative patient whose head cannot be securely and safely stabilized. Ideally, nonmechanical techniques such as positive air pressure should instead be attempted in these patients.