Foreign Body in the Nose

A foreign body in the nose occurs when an object becomes lodged inside the nasal cavity. This condition is most common in young children between ages 1-6, who often insert small objects into their noses out of curiosity. Prompt recognition and appropriate management are essential to prevent complications such as infection, tissue damage, or the object moving deeper into the respiratory tract.

Medical Disclaimer: This information is for educational purposes only and should not replace professional medical advice. If you suspect a foreign body in the nose, especially in a child, seek medical attention promptly. Do not attempt removal without proper medical guidance.

Overview

Foreign bodies in the nose are objects that become lodged within the nasal cavity, typically in the anterior (front) portion where the nasal passages are narrower. This condition represents one of the most common ear, nose, and throat emergencies in pediatric patients, accounting for approximately 20% of all ENT emergency visits in children.

The nasal cavity is a complex structure with turbinates (bony structures that filter and warm air) and narrow passages that can easily trap foreign objects. Most nasal foreign bodies lodge in the inferior meatus, the space beneath the inferior turbinate, where they can cause immediate discomfort and potential complications if not removed promptly.

Common objects include beads, toys, food items, batteries, magnets, and organic materials. The location and composition of the foreign body determine the urgency of removal and potential complications. Button batteries and magnets require immediate emergency intervention due to their potential to cause severe tissue damage within hours.

Symptoms

The symptoms of a nasal foreign body can vary depending on the size, shape, and composition of the object, as well as how long it has been present. Some children may be asymptomatic initially, making detection challenging.

Immediate Symptoms

  • Nasal congestion - often unilateral (one-sided) obstruction
  • Discomfort or pain in the affected nostril
  • Difficulty breathing through the affected nostril
  • Visible object in the nostril (if positioned anteriorly)
  • Sneezing or attempts to blow the nose

Progressive Symptoms

  • Foul-smelling nasal discharge (often unilateral)
  • Bloody nasal discharge or nosebleeds
  • Purulent (pus-containing) drainage
  • Crusting around the nostril
  • Mouth breathing due to nasal obstruction

Associated Symptoms

  • Regurgitation - particularly if the child attempts to forcefully blow their nose
  • Irritability or distress (especially in young children)
  • Sleep disturbances due to breathing difficulties
  • Decreased appetite (difficulty eating while breathing through mouth)
  • Facial pain or pressure sensation

Complications-Related Symptoms

  • Fever (indicating secondary infection)
  • Facial swelling or redness
  • Severe unilateral nasal pain
  • Thick, colored nasal discharge
  • Difficulty sleeping or eating
  • Signs of respiratory distress

Causes

Foreign bodies in the nose typically result from deliberate insertion by children, though accidental placement can also occur. Understanding the common causes helps in prevention and early recognition.

Deliberate Insertion

The most common cause, especially in toddlers and preschoolers:

  • Natural curiosity and exploration behavior
  • Imitation of adult behaviors (nose picking)
  • Boredom or attention-seeking behavior
  • Playing with small objects

Common Foreign Body Types

  • Toys and beads: Small plastic toys, marbles, beads, LEGO pieces
  • Food items: Nuts, seeds, popcorn kernels, small candies
  • Household items: Buttons, coins, paper wads, erasers
  • Organic materials: Leaves, twigs, insects (may enter accidentally)
  • Medical items: Cotton swab tips, medication fragments

High-Risk Objects

  • Button batteries: Can cause chemical burns within 2-4 hours
  • Magnets: Risk of attraction to metal objects, tissue damage
  • Sharp objects: Risk of perforation and bleeding
  • Hygroscopic materials: Items that swell when wet (foam, seeds)

Accidental Insertion

  • During eating (food particles)
  • Playing outdoors (insects, plant material)
  • Medical procedures (retained gauze or cotton)
  • Trauma to the face

Risk Factors

Certain factors increase the likelihood of nasal foreign body incidents. Identifying these risk factors helps parents and caregivers implement appropriate preventive measures.

Age-Related Factors

  • Peak age: 1-6 years
    • Peak incidence at 2-3 years
    • Natural curiosity and exploration phase
    • Limited understanding of consequences
    • Developing fine motor skills

Developmental and Behavioral Factors

  • Developmental delays or intellectual disabilities
  • Autism spectrum disorders
  • Attention deficit hyperactivity disorder (ADHD)
  • History of self-injurious behaviors
  • Pica (tendency to eat non-food items)

Environmental Factors

  • Access to small objects and toys
  • Inadequate supervision
  • Presence of older siblings with small toys
  • Daycare or group childcare settings
  • Homes with multiple small children

Previous History

  • Previous foreign body incidents
  • History of putting objects in other orifices (ears, mouth)
  • Family history of foreign body incidents
  • Chronic nasal picking habits

Diagnosis

Diagnosing a nasal foreign body requires a careful history, physical examination, and sometimes imaging studies. Early diagnosis is crucial to prevent complications and facilitate safe removal.

Clinical History

Key historical information includes:

  • Witnessed insertion: Direct observation by caregiver
  • Timing: When the object was inserted or symptoms began
  • Object description: Size, shape, composition if known
  • Previous attempts at removal: By patient or caregivers
  • Associated symptoms: Discharge, bleeding, pain

Physical Examination

Visual Inspection

  • External nasal examination for swelling or discharge
  • Anterior rhinoscopy with adequate lighting
  • Use of nasal speculum for better visualization
  • Assessment of object location and accessibility

Signs on Examination

  • Visible foreign body in anterior nasal cavity
  • Unilateral nasal discharge or crusting
  • Mucosal edema or inflammation
  • Foul odor from affected nostril
  • Bleeding or tissue trauma

Imaging Studies

When Imaging is Indicated

  • Suspected but not visible foreign body
  • Radiopaque objects requiring localization
  • Concern for complications (sinusitis, intracranial extension)
  • Multiple foreign bodies suspected

Imaging Modalities

  • Plain radiographs: Limited utility, only for radiopaque objects
  • CT scan: Gold standard for complex cases
  • Endoscopy: Direct visualization and potential removal

Differential Diagnosis

  • Acute sinusitis
  • Allergic rhinitis
  • Nasal polyps
  • Upper respiratory infection
  • Deviated nasal septum
  • Tumors (rare in children)

Treatment Options

Treatment of nasal foreign bodies requires prompt but careful approach to prevent pushing the object deeper or causing injury. The method of removal depends on the object's characteristics, location, and patient cooperation.

Initial Assessment and Preparation

  • Patient preparation: Calm environment, parental presence
  • Equipment preparation: Proper lighting, suction, visualization tools
  • Safety considerations: Restraint if necessary, emergency equipment ready
  • Risk assessment: Object type, location, patient cooperation

Non-Invasive Removal Techniques

Positive Pressure Technique (Parent's Kiss)

  • Procedure:
    • Occlude the unaffected nostril
    • Parent gives gentle mouth-to-mouth breath
    • Positive pressure may dislodge object
  • Success rate: 60-80% for appropriate cases
  • Contraindications: Sharp objects, deeply embedded items

Self-Removal Techniques

  • Gentle nose blowing (if child is capable)
  • Occlude unaffected nostril during blowing
  • Avoid forceful blowing that may push object deeper

Medical Removal Techniques

Instrumentation

  • Forceps: For graspable objects
  • Curettes: For round or smooth objects
  • Hooks: To get behind the object
  • Suction: For appropriate objects
  • Balloon catheters: Pass behind object and inflate

Endoscopic Removal

  • Direct visualization with nasal endoscope
  • Precise removal under direct vision
  • Minimal trauma to surrounding tissues
  • Preferred for complex or deeply located objects

Emergency Procedures

Indications for Urgent Removal

  • Button batteries (within 2-4 hours)
  • Magnets (especially if multiple)
  • Sharp objects causing bleeding
  • Objects causing respiratory distress
  • Signs of infection or complications

Surgical Intervention

  • General anesthesia: For uncooperative patients or complex cases
  • Surgical approach: External approach for deeply embedded objects
  • Post-operative care: Antibiotics, nasal irrigation, follow-up

Post-Removal Care

  • Nasal decongestants to reduce swelling
  • Antibiotic therapy if infection present
  • Nasal saline irrigation
  • Follow-up examination in 24-48 hours
  • Prevention counseling for families

Prevention

Prevention of nasal foreign bodies involves environmental modifications, appropriate supervision, and education of children and caregivers about the risks associated with placing objects in the nose.

Environmental Safety Measures

  • Childproofing: Remove or secure small objects that could fit in nasal cavity
  • Toy safety: Age-appropriate toys without small detachable parts
  • Storage: Keep small items (coins, batteries, jewelry) out of reach
  • Regular cleaning: Remove small debris from floors and play areas
  • Sibling awareness: Educate older children about keeping small toys away from younger siblings

Supervision and Education

  • Age-appropriate supervision: Close monitoring during play, especially ages 1-6
  • Child education: Simple, age-appropriate explanations about nose safety
  • Positive reinforcement: Praise children for keeping objects out of their nose
  • Caregiver education: Training for babysitters, daycare providers

Special Considerations

  • High-risk children: Extra precautions for children with developmental delays
  • Medical devices: Secure placement of nasal cannulas, feeding tubes
  • Food safety: Avoid small, hard foods that could become lodged
  • Emergency planning: Know when and where to seek help

Community Prevention

  • Daycare and school safety protocols
  • Public awareness campaigns
  • Healthcare provider education
  • Product safety standards and regulations

When to See a Doctor

Seek immediate emergency care for:

  • Button battery in the nose (requires removal within 2-4 hours)
  • Multiple magnets or magnet with metal objects
  • Sharp objects causing bleeding
  • Signs of respiratory distress or difficulty breathing
  • Severe pain or bleeding that won't stop
  • Signs of infection: fever, facial swelling, severe discharge

Schedule urgent appointment for:

  • Any suspected foreign body that cannot be safely removed at home
  • Object visible but not easily accessible
  • Foul-smelling unilateral nasal congestion
  • Persistent bleeding or discharge
  • Child reporting something in their nose

Do NOT attempt removal if:

  • Object is not clearly visible
  • Object is deeply embedded
  • Sharp or dangerous objects
  • Previous unsuccessful attempts
  • Child is uncooperative or distressed

Related Conditions

References

  1. Kiger JR, Brenkert TE, Losek JD. Nasal foreign body removal in children. Pediatr Emerg Care. 2008;24(11):785-792.
  2. Kadish H. Ear and nose foreign bodies: "It is all about the tools". Clin Pediatr (Phila). 2005;44(8):665-670.
  3. Chai YC, Tang IP, Tan TY, et al. A review of nasal foreign bodies in children: correlation of aural foreign bodies. Int J Pediatr Otorhinolaryngol. 2006;70(9):1613-1616.
  4. Thompson SK, Wein RO, Dutcher PO. External auditory canal foreign body removal: management in the emergency department. Acad Emerg Med. 2003;10(8):918-922.
  5. Dane S, Smally AJ, Peredy TR. A truly emergent problem: button battery in the nose. Acad Emerg Med. 2000;7(2):204-206.