Rhinology A7


Foreign body in the nose

Intranasal foreign bodies occur most commonly in young children. There is also a higher prevalence of foreign body insertion among young children and adults with neurodevelopmental disorders such as ADHD. In most cases, intranasal foreign bodies are asymptomatic and can be removed at first presentation without referral to ENT. 

Organic (food and bugs) and inorganic (nails, paper, stones etc.) objects can be inserted at varying depths in the nasal cavity. Organic objects can cause local inflammatory reactions and secondary infections leading to sinusitis. Typical presentations include unilateral purulent and foul-smelling discharge, nasal obstruction and facial pain from sinusitis. 

Inorganic objects tend to be asymptomatic unless they are large enough to cause nasal obstruction. Depending on the patient and the object’s size, depth and smoothness dictates the method of extraction whether it be through positive pressure methods or by instrumentation with or without sedation. 

After a foreign body is removed from the nasal cavity, careful examination of the involved nasal cavity and other orifices are required. Ears and sinuses on the affected side could have acute otitis media or sinusitis if the foreign body has been present for prolonged duration.

Button batteries require emergency removal because they can cause tissue necrosis through electrolysis at the negative battery pole. If the negative pole is directed towards the septum, septal perforation can occur in 4 hours. Button batteries in the nose tend to present with purulent discharge and epistaxis. In associated tissue necrosis, black discharge, facial swelling and pain plus fever may occur.

Correct Answer: