Young children are naturally curious creatures and spend a great
deal of time investigating themselves and the world around them.
This involves handling, tasting, and smelling whatever they get their
hands on. When these investigations go too far, the Emergency Physician
is faced with a foreign body in a youngster’s nose. Adult
patients with mental retardation or psychiatric conditions may also
present with nasal foreign bodies. Several methods are available
for removing these objects, including manual removal under direct
vision, catheter removal, or positive pressure.
The nasal cavity consists of two passages on either side of the
nasal septum. The superior, middle, and inferior bony turbinates
project into each passage and are covered by a mucous membrane overlying
a venous plexus. The cartilaginous septum is covered by a thin mucosa
and receives its blood supply from the mucoperichondrium. Sensory
nerves of the nasal cavity are branches of the greater palatine
nerve and sphenopalatine ganglion.1 These nerves are easily
numbed with topical anesthetics. The nasal cavity is separated from
the orbit by the thin lamina papyracea and from the anterior cranial
fossa by the cribriform plate of the ethmoid bone.
A foreign body in the nasal cavity sets off an inflammatory response
and the venous plexus becomes congested. This swelling may eventually
obscure the object from view. The longer the object remains in the
nasal cavity, the more likely the patient is to develop pressure
necrosis, granulation tissue, and a purulent discharge. A unilateral
malodorous discharge and/or epistaxis from a child’s
nose is the hallmark of a foreign body.
The presence of a disk or button battery
in the nasal cavity requires urgent removal. The moisture in
the nasal cavity may cause leakage of the battery and a low-voltage
direct current between the anode and cathode. This may cause tissue
electrolysis and destruction of the mucosa, cartilage, and bone
within hours.1 These patients need to be seen and followed
by an Otolaryngologist after the battery is removed. An electrical
burn may cause damage to the nasal tissues that is more extensive
than is visible initially in the Emergency Department. Patients
may develop a delayed septal perforation and alar collapse from
extensive tissue damage.2
The presence of a foreign body in the nasal cavity is an indication
for its removal. All nasal foreign bodies must be removed to prevent
erosion of the nasal tissues and possible aspiration.
There are only a few contraindications to the removal of a nasal
foreign body in the Emergency Department. One contraindication is
if the airway is in danger. This might be due to a posteriorly placed
foreign body or an uncooperative patient. An impacted foreign body
should be removed under general anesthesia. If a larger object has
entered the nose traumatically, the object should be removed by
the appropriate consultant, as it may have penetrated the cranial
cavity, the orbit, or a sinus cavity.3...