Foreign body - Nasal

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full PCH Emergency Department disclaimer.

Aim 

To guide staff with the assessment and management of nasal foreign body.

Background

  • Foreign body insertion in the nose in paediatrics is a common presentation to the ED.
  • It is more common in children less than 7 years or those with intellectual impairment.
  • Most patients present on the day of insertion but occasionally this may be delayed for days / weeks and can present as an offensive nasal discharge or may be discovered incidentally on routine examination.

Key points

Types of foreign body:
  • A large variety of objects have been implicated. These include beads, plastic toys, vegetation and food.
  • The most serious retained FB is the button battery that can cause mucosal damage and necrosis.
Children with nasal foreign bodies tend to be younger than other ENT foreign bodies. 

Assessment

History

  • Local pain
  • Nasal discharge 
  • Epistaxis
  • Admission by child
  • Rhinitis
  • Difficulty breathing
  • Sensation of swelling. 

Examination

  • Foreign body is usually seen on direct vision

Investigations

  • Usually none indicated

Management

  • Accurate identification of foreign body is essential prior to removal to guide removal technique.
  • Ensure good lighting preferably with headlight.
  • A cooperative or restrained patient is necessary and this may require sedation techniques See Procedural Sedation.

Nasal co-phenylocaine may be used to reduce swelling and may help in the expulsion of the foreign body. 

Removal options

  • Forced air using air viva and occlusion of opposite nostril.
Nasal positive press
  • Suction – may be used but requires a smooth spherical object provide a good seal.
  • Forceps – can grasp some objects but often will slip on rounded objects and push the object further in.
  • Hook – insert along medial wall of nostril with hook pointing cranially and then pass hook behind the object and rotate hook laterally to bring hook behind object and withdraw object.
  • Irrigation.
  • Glue on a stick.
  • ENT referral for fibre optic endoscopy.

Complications of removal

  • Trauma
  • Bleeding
  • Aspiration.

Bibliography

  1. Isaacson GC, Aderonke O (2014) Diagnosis and Management of Intranasal Foreign Bodies. UpToDate 


Endorsed by:  Director, Emergency Department   Date:  Mar 2018


 Review date:   Feb 2021


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