Foreign body in the nose

• young children aged 1 - 4 years may put foreign bodies up one or both nostrils
• rarely, in an adult, nasal obstruction may be caused by a rhinolith which consists of layers of calcium and magnesium salts formed around a central nucleus - often a foreign body.
• common nasal foreign bodies include
  • beads, buttons, toy parts, pebbles, candle wax, food, paper, cloth, and button batteries (1)
• common sites where nasal foreign bodies tend to get lodged are: (1)
  • on the floor of the nasal passage, just below the inferior turbinate
  • in the upper nasal fossa anterior to the middle turbinate
• clinical features include:
  • foul-smelling nasal discharge (1)
  • discharge may occasionally blood stained
  • excoriation around the nostril
• management (1)
  • seek expert advice
  • 0.5% phenylephrine can be used to reduce mucosal edema before removal of foreign body
  • topical lidocaine can be applied as an analgesic
  • techniques include removal with direct visualization using
    • forceps
    • curved hooks
    • cerumen loops
    • suction catheters
• complications
  • there is danger of injury from clumsy attempts at removal by an unskilled person
  • a nasal foreign body carries the danger of inhalation into the lungs and subsequent formation of a lung abscess
  • there may be a local spread of infection to cause a sinusitis or meningitis.

Reference:

1. Heim SW et al. Foreign bodies in the ear, nose, and throat, Am Fam Physician 2007;76:1185-9.