Foreign Body

A nasal foreign body should be suspected in a child with or without a history of previous nasal problems who presents with recent unilateral nasal obstruction, rhinorrhea, and odor. The nasal foreign body might not be visible secondary to the presence of mucosal edema, mucus, or pus.

If the foreign body is identified, removal may be attempted in a cooperative child. If removal is not possible or the diagnosis is uncertain, ENT consultation should be obtained. The ENT evaluation may be done in the office setting or in the operating room, depending again on patient cooperation and degree of suspicion. The nasal cavity is suctioned, decongested, and anesthetized with topical lidocaine. Endoscopy may be done. If the foreign body is seen, removal is undertaken.

If old enough, asking the child to blow the nose after decon-gestion might remove the foreign body or at least move it anteriorly. Removal can be difficult, and experience helps. Problems that can hinder removal include bleeding that obscures visibility. The foreign body can also be inadvertently pushed posteriorly. Softer foreign bodies, such as food matter and tissue paper, can disintegrate, requiring piecemeal removal.

A headlight and bivalve nasal speculum are recommended. Suction should be available. A small alligator or bayonet forceps is sometimes used, but may simply push the foreign body posteriorly. In many cases a useful instrument is a small, ball-tipped, right-angle probe, actually an otologic surgical instrument called an "attic hook." This can be gently passed posterior to the foreign body, turned 90 degrees, and then used to pull the foreign body anteriorly and out of the nose.

Once the foreign body is removed, the nasal cavity should be reinspected for retained, more distal foreign bodies. The other nasal cavity and ears should also be inspected because the child might be a "repeat offender." Antibiotics are recommended if there is evidence of obvious infection or complete removal is not certain and reexamination is planned.

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