Nasal foreign bodies (NFBs) are a common issue seen in emergency departments, particularly among children.
However, adults with psychiatric conditions or developmental disabilities may also present with foreign bodies in the nasal cavity.
While most nasal foreign bodies are benign, some can cause serious health issues, including infection, bleeding, and even airway obstruction.
Early detection and appropriate management are crucial in preventing complications.
What Are Nasal Foreign Bodies and Why Do They Occur?
Definition:
A nasal foreign body is any object that becomes lodged in the nasal cavity. These objects can vary widely, ranging from everyday items like beads, peanuts, and toys to more dangerous materials like batteries or magnets.
Foreign bodies can either be inanimate (non-living) or animate (living organisms like insects). Organic objects like food or small plant parts tend to cause irritation or infection more quickly than inanimate objects, whereas inorganic objects may go unnoticed for longer periods.
What are the Causes and Risk Factors?
Nasal foreign bodies are most frequently seen in children, especially those aged 2 to 5, as they explore their bodies and environment.
This age group is particularly prone to inserting small objects into their noses out of curiosity.
Children younger than nine months usually don’t have the fine motor skills to perform this act.
Boys are generally more likely to insert foreign objects into their nostrils than girls.
In addition to children, nasal foreign bodies are sometimes found in adults, especially those with psychiatric disorders or developmental disabilities. For these individuals, repeated insertion of objects may be behavior related to the condition.
Button batteries and magnets are particularly hazardous when lodged in the nose.
They can cause severe damage, including septal perforation and necrosis, due to chemical reactions and electrical currents between the objects and the tissue.
How Are Nasal Foreign Bodies Detected?
Symptoms and Clinical Presentation:
The signs and symptoms of a nasal foreign body may vary based on the object’s size, location, and nature. However, most cases share a few common features:
- Foul-smelling nasal discharge (usually from one side).
- Nasal blockage or difficulty breathing.
- Epistaxis (nosebleeds) or blood-stained discharge.
- Irritability or discomfort, especially in younger children.
- In cases where the foreign body is alive (e.g., insects), symptoms may be more severe, with bilateral discharge and potential tissue destruction.
In some cases, children may inform their parents that they’ve inserted something into their noses. However, in younger children, or those who cannot communicate clearly, irritability and persistent crying may be the only signs of a foreign object. For example, if the object is a living organism like an insect, the child might also complain of a tickling sensation, sneezing, or headache.
Complications of Delayed Detection:
If a foreign body is not detected and removed promptly, it can lead to complications. Inorganic objects, such as small beads or plastic, may remain lodged for a long time without causing noticeable symptoms. However, organic foreign bodies like food can swell, leading to mucosal erosion, ulceration, and even secondary infections.
More dangerous objects, such as button batteries and magnets, can cause rapid tissue damage, including rhinolith formation (hardened masses of foreign material) and septal perforation. These objects may also cause necrosis (tissue death) due to electrical currents or chemical reactions within the body, leading to potentially permanent damage.
Diagnostic Approach:
Examination should begin with a thorough physical exam, especially anterior rhinoscopy, which allows the doctor to visually inspect the nasal cavity.
If the object is difficult to visualize, additional tools such as a fibreoptic nasopharyngoscopy may be used.
In some cases, if the object cannot be easily seen, imaging studies like X-rays, CT scans, or MRI can help identify the foreign body. Imaging is particularly useful when a button battery or magnet is suspected, as these objects can be radiopaque and thus visible on X-rays.
In the case of a living foreign body, symptoms like unilateral discharge or swelling may be indicative, and further evaluation of the white blood cell count may reveal signs of infection. Chest X-rays are often needed if there is a concern that the object has been aspirated into the airway, potentially leading to respiratory distress.
What Are the Risks Associated with Nasal Foreign Bodies?
Morbidity and Mortality:
While most cases of nasal foreign bodies are benign and do not lead to major complications, the risks increase with certain objects or when removal is delayed. Some potential complications include:
- Nasal Septal Perforation: Particularly with button batteries, the direct tissue damage caused by leakage of battery acid can lead to permanent perforations in the nasal septum.
- Meningitis and Sinusitis: If an object causes an infection, the risk of sinusitis or even meningitis (infection of the brain and spinal cord) increases, especially in children.
- Respiratory Complications: Objects may migrate into the respiratory tract, leading to aspiration, respiratory arrest, or acute otitis media (middle ear infection).
- Periorbital Cellulitis: If a foreign body is not properly removed, it can cause orbital infections that spread to the skin around the eyes.
- Tetanus: Though rare, some foreign bodies (e.g., rusty nails or objects with bacteria) may lead to tetanus, a potentially fatal bacterial infection.
Long-Term Effects:
In most cases, if treated early, nasal foreign bodies do not cause long-term issues. However, objects that are left untreated for an extended period can cause chronic nasal obstruction, sinusitis, or persistent nasal discharge. The risk of chronic complications increases when foreign bodies are difficult to detect, such as radiolucent objects (like some plastic items) that do not appear on X-rays.
How Are Nasal Foreign Bodies Managed?
Treatment Approaches:
Removing a nasal foreign body involves careful examination, proper lighting, and often the use of instruments. The treatment can be divided into several steps:
- Initial Assessment: Ensure a clear airway and make sure the patient is in a comfortable position. Vasoconstrictors (e.g., nasal decongestants) can be used to shrink the nasal mucosa, making the foreign body easier to visualize.
- Direct Visualization and Extraction: Instruments such as forceps, curettes, or alligator forceps can be used to grab and remove the foreign body. For smooth objects like beads, a probe can be used to pull the object out.
- Alternative Methods:
- The “Parent’s Kiss” technique involves the parent or caregiver sealing their mouth over the child’s mouth and blowing air into the nostrils while occluding the unaffected nostril.
- Suction devices (flexible catheters or Yankhauer) can be used for softer or smaller objects.
- For cooperative patients, a small amount of glue can be applied to a cotton swab to remove spherical objects by adhesion.
- Caution with Sedation: For uncooperative children, sedation may be necessary. However, sedation carries a risk of aspiration, and advanced airway equipment should be available during the procedure.
When to Seek Specialist Help:
- If a button battery, magnet, or object has migrated posteriorly, or if the object is deep in the nasal cavity, ENT specialists should be consulted. They may use advanced techniques, such as nasal endoscopy or even surgery, to remove the object safely.
How Can Nasal Foreign Bodies Be Prevented?
Prevention Strategies:
Parents and caregivers should be vigilant in preventing children from inserting objects into their noses. Here are some key preventive measures:
- Supervision during play is essential, especially with toys that have small parts or batteries.
- Keep small objects, batteries, and magnets out of reach of young children.
- Educate children about the dangers of putting objects in their noses, ears, or mouths.
- In children with developmental disorders, particularly those with autism spectrum disorder, parents should be aware of the increased likelihood of repeated insertion of foreign objects.
Emergent Preparedness:
- If a foreign body becomes lodged in a child’s nose, parents can attempt the Parent’s Kiss technique.
- Medical attention should be sought immediately if the object is large, sharp, or potentially dangerous (like a button battery).
Why Choose Asian ENT Care Centre?
At the Asian ENT Care Centre, we understand how distressing nasal foreign bodies can be for both children and parents. Our expert team provides the safest and most effective treatments. Whether you need urgent care for a foreign body or want to ensure your child’s nose is safe, we’re here to help.
Schedule a consultation today and let us assist you in resolving nasal issues quickly and safely!
