Foreign Body Nose

Children between the ages of 1 and 4 years sometimes insert foreign bodies into one or both nostrils.The objects of their choice may be hard, such as buttons,beads or ball bearings,or soft,such as paper,cotton wool, rubber or other vegetable materials;the latter,being as a rule more irritat- ing,tend to give rise to symptoms more quickly. The child,however intelligent,is unlikely to indicate that a foreign body is present in his nose;he may,in fact,deny the possibility in order to avoid rebuke.A sibling may give the game away.


CLINICAL FEATURES

1 A fretful child.

2 Unilateral evil-smelling nasal discharge,sometimes blood-stained.

3 Excoriation around the nostril.

4 Occasionally,X-ray evidence.


DANGERS

1 Injury from clumsy attempts at removal by unskilled persons.

2 Local spread of infection—sinusitis or meningitis.

3 Inhalation of foreign body—leading to lung collapse and infection.


MANAGEMENT

Casualty officers in particular should be alive to the possibility of nasal for- eign bodies in small children.The child’s mother may say that she suspects a foreign body,or the presence of a foreign body may be obvious.On the other hand, there is often an element of uncertainty, and full reassurance cannot be given until every step has been taken to reveal the true state of affairs.When in doubt,call in expert advice. In the case of a cooperative child it may be possible, with head-mirror (or lamp) and Thudichum’s speculum,to see and,with small nasal forceps or blunt hooks,to remove the foreign body without general anaesthetic.Local analgesia and decongestion are helpful and may be applied in the form of a small cotton-wool swab wrung out in lidocaine/phenylephrine solution. Extreme care is necessary. A refractory child should,from the onset,be regarded as a case neces-sitating general anaesthesia.This must be administered by an experienced anaesthetist, and it is usual to employ an endotracheal tube.The surgeon may then remove the foreign body and need have no fear that it will enter the trachea. Rarely,an adult complaining of nasal obstruction is found to have a large concretion blocking one side of the nose.This is a rhinolith,and consists of many layers of calcium and magnesium salts that have formed around a small central nucleus.The latter often contains a foreign body.