Otolaryngology Book

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Nasal Foreign Body

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  1. See Also
    1. Ear Canal Foreign Body
    2. Airway Foreign Body
    3. Esophageal Foreign Body
  2. Epidemiology
    1. Common in children and developmentally disabled
  3. Etiology
    1. Inorganic Materials (Beads, Pebbles, Wax, Button batteries)
    2. Organic Materials (Beans, Peas)
      1. Tend to swell and soften
      2. Makes removal more difficult
  4. Signs
    1. Unilateral foul smelling discharge
    2. Nasal obstruction
    3. Vasoconstriction makes foreign body more easily seen
  5. Precautions
    1. Do not push posteriorly (May result in aspiration)
    2. Button batteries require immediate removal
  6. Management: Patient attempts to expell foreign body
    1. Blow nose with opposite nare occluded
    2. Trial of insufflation
      1. Occlude opposite nostril (e.g. with finger)
      2. Parent blows into mouth (or with Ambu Bag)
      3. Avoid using excessive pressure or volume
      4. Forces air through nostril with foreign body
  7. Management: Clinician attempted removal in clinic
    1. Pretreatment
      1. Phenylephrine 0.5% (Neo-Synephrine) or Afrin
      2. Conscious Sedation may be required in young or developmentally delayed patients
    2. Procedures and Instruments
      1. Fogarty or Foley Catheter (lubricated 5-6 french catheter)
        1. Insert behind foreign body, inflate balloon and then pull out with foreign body
      2. Forceps (Alligator or bayonet)
      3. Cerumen curette
  8. Management: Referral indications
    1. Foreign body refractory to removal attempts
    2. Chronic foreign body with significant localized reaction
  9. References
    1. Chan (2004) J Emerg Med 26:441
    2. Heim (2007) Am Fam Physician 76:1185
    3. Kalan (2000) Postgrad Med J 76:484

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