Foreign body of the Nose
• Most common age range: 2-5 yo
• Most common FB: beads, beans, peanuts, toy parts
• Beware of: button batteries and two magnets, as always.
• Can lead to septal perforation/necrosis of tissue.
• Be suspicious of nasal FB when you see unilateral discharge, often malodorous
• Complications: infection, aspiration, epistaxis
To remove:
• Topical lidocaine or afrin?
Pro: improve tolerance of/cooperation with the procedure
Con: risks displacement of the FB
How to remove
1) Mechanical extraction: You need a cooperative child and good visualization.
2) Suction: must exercise extreme caution not to push further back and aspirated into the trachea
3) Positive Pressure: Parent’s kiss, bag mask, continuous pressure
Start by asking the child to blow their nose, occluding the unaffected nostril as they do this. Sometimes, this alone may expel the foreign body.
Parent’s Kiss: One of my preferred methods. Has a 50 % success rate.
Kissing parent: The technique is performed by a parent by placing their mouth over the child’s (giving a ‘big kiss’), while they occlude the unaffected nostril. The parent then exhales into the child’s mouth, generating positive pressure, similar to that of nose blowing. See picture below for demonstration.
Nothing working? You may need an ENT consult because the FB is so posterior that above methods are futile.
Now that it’s removed:
· Don’t forget to inspect for trauma or retained FB
References:
• PEM playbook foreign bodies: excellent peds podcast by Dr. T Horeczko - 2015
• Wiki EM: Nose foreign body
Look at this retro parent’s kiss!