Foreign Body in Nose

Most cases of nasal foreign bodies are not serious and occur in children from 1-8 years of age who have voluntarily placed the foreign body in their nose. (See exception, Urgent Evaluation, below.) Common objects found in noses include food material, tissue paper, beads, toys, and rocks. When questioning children about the possibility of a nasal foreign body,  approach them in a nonjudgmental manner to avoid the increased risk that the child will deny having put something in their nose to avoid punishment. This could easily result in a delay of its discovery and increase the risk of complications.

An object stuck in the nose, however, does have the potential to dislodge and move into the mouth where there is the danger of swallowing it, or perhaps inhaling it into the lungs, which could cause choking.  Health care professionals may be unable to adequately assess the urgency of the situation over the telephone.  If there is any concern for the presence of a foreign body in the nose, the person should be physically examined by a qualified medical professional. Additionally, any time there is a chance that the child has placed a magnet or any button battery (from hearing aids or toys) in their nose, the child must be evaluated immediately due to the risk of severe chemical burns and tissue damage.

Symptoms

Nasal foreign bodies tend to go unrecognized for longer periods of time than do foreign bodies in the ear because they usually produce fewer symptoms and are more difficult to visualize. Foreign bodies can be classified as either inorganic or organic. Inorganic materials are typically plastic or metal and commonly include beads, small earrings, and small parts from toys. With inorganic foreign bodies, the child may be asymptomatic and the foreign body will be discovered incidentally on a routine exam. In contrast, organic foreign bodies, including food, rubber, wood, and sponges, tend to swell and be more irritating to the nasal mucosa, thus producing earlier symptoms. Peas, beans, nuts and popcorn kernels are among the more common organic nasal foreign bodies seen in pediatric patients.

Typically, foreign items in the nose may result in any of the following symptoms: complaints of pain or difficulty breathing through that side of the nose; nasal bleeding; continuing nasal discharge from one side of the nose, often leading to sinusitis due to blockage of sinus drainage; and foul odor from the nose or mouth if the object has been present for a prolonged period (sometimes over a year or longer). Firmly impacted and unrecognized foreign bodies can in time become coated with calcium, magnesium, phosphate, or carbonate and become a rhinolith. Rhinoliths are visible on X-ray and typically are found on the floor of the nasal cavity. Rhinoliths can remain undetected for years and only upon growth produce symptoms that lead to their discovery.

The nasal space connects to the back of the mouth, so it is also possible for an object to be pushed back into the throat resulting in swallowing or choking on the object. Complaints of choking, wheezing, difficulty breathing, or inability to talk should prompt an evaluation of the entire nose and throat in addition to the lungs so that foreign bodies will not be overlooked.

Removal

In the majority of cases a foreign object stuck in the nose will not be life-threatening. The patient will have time to call a primary care doctor. The urgency of the situation primarily depends on the location of the object, the substance involved, and the symptoms. An object that is simply stuck in the nose and not causing other symptoms can usually wait until morning or the following day for removal. The object does, however, have to be completely removed quickly and without discomfort and danger.

Nasal foreign body removal may be attempted by an experienced clinician if the object can likely be extracted. If doubt exists about the reasonable probability of extraction, an otolaryngologist should be consulted. Repeated attempts at removal may result in increased trauma and potential movement of the item into a less favorable location. Mechanical removal of a foreign body should not be attempted if the item appears to be out of range for instrumentation. On some occasions, as with the removal of a foreign body from the ear canal, the pediatric patient may have to undergo general anesthesia for the safe removal of the object.

Urgent Evaluation

An urgent evaluation at an emergency room is indicated if the child has inhaled the foreign body and is choking; if the child has swallowed it and it is lodged in the esophagus or in the stomach; or if the object is either a magnet or a small battery.