eMedicine Specialties > Clinical Procedures > Otolaryngologic and Dental Procedures

Foreign Body Removal, Nose

Author: Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Contributor Information and Disclosures

Updated: Mar 29, 2009

Introduction

Nasal foreign bodies that require removal are relatively common among pediatric patients and may also be seen in adult patients, most often those with psychiatric disease or developmental delay. The patient may present asymptomatically after having been witnessed inserting the item. Alternatively, the patient may have unilateral nasal drainage, foul odor, sneezing, epistaxis, or pain. Patients often deny having placed the foreign body; if the diagnosis is considered, this history should not lower the practitioner’s suspicion.

Any object of appropriate size may be found to have been inserted within the nose. Common items include toy pieces; beads; rocks; paper; and food items such as peas, beans, or nuts.1 Small button batteries are of particular concern, as they may, within hours to days, cause chemical burns, ulceration, and liquefaction necrosis, leading to septal perforation.2,3

When the patient presents immediately or soon after insertion, the physical examination is typically remarkable only for the presence of the foreign body. The object can be found in any area of the nasal cavity, though objects are most predictably below the inferior turbinate or immediately anterior to the middle turbinate.4 Occasionally, evidence of local trauma may exist with erythema, edema, bleeding, or a combination thereof. After prolonged exposure, an increase in these findings is likely to be observed, as well as the presence of nasal discharge and a foul odor.

Numerous techniques of foreign body removal have a broad range of success rates. The method of choice depends on multiple factors, including the level of patient cooperation, the composition of the foreign material, and the expertise of the practitioner performing the procedure.

Indications

  • 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.

Contraindications

  • Mechanical removal of a foreign body should not be attempted if the item appears to be out of range for instrumentation.
  • Removal should not be performed without adequate sedation in an uncooperative patient whose head cannot be securely and safely stabilized. Ideally, nonmechanical techniques such as positive air pressure should instead be attempted in these patients.

More on Foreign Body Removal, Nose

Overview: Foreign Body Removal, Nose
Treatment & Medication: Foreign Body Removal, Nose
References
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References

  1. Figueiredo RR, Azevedo AA, Kós AO, Tomita S. Complications of ent foreign bodies: a retrospective study. Braz J Otorhinolaryngol. Jan-Feb 2008;74(1):7-15. [Medline].

  2. McRae D, Premachandra DJ, Gatland DJ. Button batteries in the ear, nose and cervical esophagus: a destructive foreign body. J Otolaryngol. Oct 1989;18(6):317-9. [Medline].

  3. Kiger JR, Brenkert TE, Losek JD. Nasal foreign body removal in children. Pediatr Emerg Care. Nov 2008;24(11):785-92; quiz 790-2. [Medline].

  4. DeWeese DD, Saunders AH. Acute and chronic diseases of the nose. In: DeWeese DD, Saunders AH. Textbook of Otolaryngology. St. Louis: Mosby; 1982.

  5. Kadish HA, Corneli HM. Removal of nasal foreign bodies in the pediatric population. Am J Emerg Med. Jan 1997;15(1):54-6. [Medline].

  6. Brown L, Denmark TK, Wittlake WA, Vargas EJ, Watson T, Crabb JW. Procedural sedation use in the ED: management of pediatric ear and nose foreign bodies. Am J Emerg Med. Jul 2004;22(4):310-4. [Medline].

  7. McMaster WC. Removal of foreign body from the nose. JAMA. Sep 14 1970;213(11):1905. [Medline].

  8. Botma M, Bader R, Kubba H. 'A parent's kiss': evaluating an unusual method for removing nasal foreign bodies in children. J Laryngol Otol. Aug 2000;114(8):598-600. [Medline].

  9. Purohit N, Ray S, Wilson T, Chawla OP. The 'parent's kiss': an effective way to remove paediatric nasal foreign bodies. Ann R Coll Surg Engl. Jul 2008;90(5):420-2. [Medline].

  10. Backlin SA. Positive-pressure technique for nasal foreign body removal in children. Ann Emerg Med. Apr 1995;25(4):554-5. [Medline].

  11. Heim SW, Maughan KL. Foreign bodies in the ear, nose, and throat. Am Fam Physician. Oct 15 2007;76(8):1185-9. [Medline].

  12. Hills RW, Brown JC, Brownstein D. Barotrauma: a complication of positive pressure for nasal foreign body removal in a pediatric patient. Ann Emerg Med. Dec 2008;52(6):623-5. [Medline].

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Further Reading

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Keywords

nasal foreign body, nasal foreign body removal, object in nose, nose foreign body, battery in nose, button in nose, nose pain, nasal pain, epistaxis, bloody nose, foul odor in nose, foul odor mucus, unilateral nasal drainage, nasal drainage

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Contributor Information and Disclosures

Author

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Prajoy P Kadkade, MD, Assistant Professor, Department of Otolaryngology and Communicative Disorders, North Shore University Hospital-Long Island Jewish Hospital System, Albert Einstein College of Medicine
Prajoy P Kadkade, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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