Nasal foreign bodies are commonly seen in children, particularly those between 1 and 4 years of age. Adult patients with mental retardation or psychiatric illness can also present to the Emergency Department with a nasal foreign body. Young children are naturally curious 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. The most common foreign bodies found are beads, food (e.g., corn, nuts, peas, and popcorn), paper, rocks, and toy parts.1,2 Nasal foreign bodies also result from attempts to clean the nose and to control bleeding. In these cases, most of the foreign bodies retrieved consist of cotton swabs, paper, or sponge material.
Children may present with a known nasal foreign body. However, other presentations are common and may be subtle. This includes body odor, halitosis, persistent unilateral nasal discharge, or recurrent epistaxis. Foreign bodies can be found during a routine examination or as an incidental finding on radiographs in the asymptomatic child.1,3,4
The task of the Emergency Physician in these cases is fourfold. First is to suspect the presence of a nasal foreign body. Second is to perform a thorough physical examination, including a search for the foreign body. Next is to visualize the foreign body. Finally, remove the foreign body efficiently and with minimal trauma.
The nasal cavity consists of two passages on either side of the nasal septum. The superior, middle, and inferior bony turbinates project medially into each passage and are covered by a mucous membrane overlying a venous plexus. Although foreign bodies can be located anywhere in the nose, most foreign bodies are found on the floor of the inferior turbinate or anterior to the middle turbinate.5 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.6 These nerves are easily anesthetized 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 foreign body from view. The longer the foreign body remains in the nasal cavity, the more likely the patient is to develop pressure necrosis, granulation tissue, infection, and a purulent discharge. The foreign body can erode into the surrounding areas over time if it is not removed. A unilateral malodorous discharge and/or epistaxis from a child's nose is the hallmark of a foreign body.
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