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

Treatment

• small children may need sedation (consider PO benzo, ketamine)
• consider afrin spray and/or lido with epi prior to attempting removal
• "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