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3.10 Nasal Foreign Bodies


Presentation

Children may admit to parents that they have inserted something into their noses, but sometimes the history is obscure and the child presents with a purulent unilateral nasal discharge. Most commonly encountered are beans or other foodstuffs, beads, pebbles, paper wads, and eraser tips. These foesign bodies usually lodge on the floor of the anterior or middle third of the nasal cavity. Occasionally, caustic material was sniffed into the nose or coughed up into the posterior nasopharynx (e.g., a ruptured tetracycline capsule), the patient will present with much discomfort and tearing, and inspection will reveal mucous membranes covered with particulate debris.

What to do:

What not to do:

Discussion

The mucous membrane lining the nasal cavity allows you the tactical advantages of vasoconstriction and topical anesthesia. In cases where patients have unsuccessfully attempted to blow foreign bodies out of their noses, they may be successful after instillation of an anesthetic vasoconstriction solution. If a patient swallows a foreign body that has been pushed back into the nasopharynx, this is usually harmless and the the patient and parents can be reassured (see Swallowed foreign body). If the object is aspirated into the tracheobronchial tree, it may produce coughing and wheezing and bronchoscopy under anesthesia will be required for retrieval. Button batteries can cause serious local damage and should be removed quickly.

References:


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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD