Nasal foreign body
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 sedation (consider PO benzo, ketamine)
- consider afrin spray and/or lido with epi prior to attempting removal
Methods
- "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 pt's mouth to expel FB
- BVM technique: similar to parent technique, close opposite nare, use BVM with tight fit over mouth, squeeze bag
- alligator forceps or bayonet forceps
- curette
- dermabond on end of long q-tip
- balloon catheter: foley catheter or fogarty catheter: snake catheter into nare behind object, fill balloon, pull object out
Complications
- tympanic membrane barotrauma from "parent's kiss" technique
- bleeding
- retained FB will need to be seen by ENT
- magnets and batteries will require removal ASAP to prevent tissue necrosis
Sources
Harwood-Nuss, Roberts and Hedges