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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.

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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.

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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.

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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

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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.

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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...

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