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Nasal foreign body
From WikEM
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
- "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
- 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 (lighted may be helpful)
- 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
- 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
