Dr Paulose

Nasal Foreign Bodies In Children

Children are often brought to the emergency department for removal of foreign bodies from the nose or ear. Some times 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 blood stained nasal discharge at times foul smelling. Most commonly encountered are beans, buttons, or other foodstuffs, beads, pebbles, paper wads, and eraser tips. These foreign bodies usually lodge on the floor of the anterior or middle third of the nasal cavity.

Examine the Child

Proper examination with a good headlight or otoscope will reveal the foreign body.

How to remove it

and Explain the procedure beforehand in detail to patient and parents. Explain that it will be a little uncomfortable, and that aspiration of the foreign body into the trachea is a real but remote possibility.

and After initial inspection using a nasal speculum and bright light, suction out any purulent discharge and insert a cotton pledget soaked in 4% lidocaine and xylometazoline to shrink the nasal mucosa and provide local anesthesia. Be careful to avoid pushing the foreign body posterior. Remove the pledget after approximately 5-10 minutes.

and If the patient is able to cooperate, have him try to blow his nose to remove the foreign body. With an infant it is sometimes possible to have the parent blow a sharp puff into the baby’s mouth while holding the opposite nostril closed to blow the object out of the nose.

and Before attempting any removal using surgical instruments, a potentially uncooperative child must be firmly restrained or sedated

and Tilley\’s forceps should be used to remove cloth, cotton, or paper foreign bodies. Pebbles, beans, and other hard foreign bodies may be rolled out by getting behind it using a Hook, a silver Eustachian catheter.

and Any bleeding can be stopped by reinserting a cotton pledget soaked in the topical solution used initially.

and After the foreign body is removed, inspect the nasal cavity again and check for additional objects that may have been placed in child\’s nose and even ears.

and Do not ignore a unilateral nasal discharge in a child. It must be assumed to be secondary to a foreign body until proven otherwise.

and Do not push a foreign body down the back of a patient’s throat, where it may be aspirated into the trachea.

Examination under General Anesthesia

If the child is uncooperative and start bleeding while attempting to remove it, then take the child to operation theatre and remove the Foreign body under anesthetic.