What is Nasal Foreign Body?
Objects stuck in the nose (nasal foreign bodies or NFB) are generally seen in emergency rooms, especially in children. Nonetheless, adults with mental health problems or developmental disabilities can also encounter this issue. Commonly, NFBs are harmless and there’s no rush to remove them, but some things, like batteries and magnets, can cause serious harm and must be removed immediately.
Sometimes, it’s obvious that there’s an object in the nose, but other times it may not be so clear. Because of this, a doctor has to be alert to the possibility, as in some cases, objects can get unnoticed and remain in the nose for weeks, months, or even years after they were first inserted.
Basically, these objects in the nose can be sorted into two categories: living organisms (like bugs) and inanimate objects, or things that come from living matter (organic) and those that do not (inorganic). Generally, organic objects (like food) tend to irritate the inside of the nose more and cause symptoms faster.
What Causes Nasal Foreign Body?
Common objects that are often found in the nose include small items like pebbles, beads, nuts, chalk, and similar items.
Apart from this, living creatures such as the larvae of flies and screw worms can also be seen, with fly maggots being more common and causing more damage.
These foreign items usually end up in two specific places in your nose: either on the floor of the lower nasal cavity or in front of the middle cavity.
Some of these objects can stay in the nose without causing any problems. Others, however, can lead to the swelling of the nose lining, causing sores, ulcers, and nosebleeds. This often happens with organic objects because they absorb water from the tissues around them and swell up. Over time, these items can harden due to mineral accumulation and turn into a ‘rhinolith’ (a stone in the nose), causing further damage.
Batteries, in particular, can harm the partition between your nostrils (nasal septum). They might cause a hole in the septum by triggering a local inflammatory response which leads to tissue decay.
Risk Factors and Frequency for Nasal Foreign Body
Button batteries are common in many items like children’s toys, remote controls, hearing aids, calculators, and much more. Over 300 of these batteries are swallowed in the United States every year.
Kids are commonly observed to put objects in their noses, as they’re intrigued by exploring their own bodies. However, it’s uncommon to see this behavior in kids under nine months, before they develop the ability to grasp objects tightly.
The age group most likely to insert items into their noses is two to five years old. Boys are slightly more likely to do this than girls.
Single foreign objects are found on the right side of the nose twice as often as the left side. This is likely due to most kids being right-handed.
- Children with autism spectrum disorder commonly insert foreign objects into various body openings multiple times, and may have multiple objects in multiple locations.
- Children who have younger siblings at home are more likely to insert objects into their noses.
- Frequently inserting objects into the nose or other body parts can be a sign of mental illness.
Signs and Symptoms of Nasal Foreign Body
If a child has a foreign body stuck in their nose, it can cause a number of noticeable symptoms. The most common is usually a foul-smelling discharge from the nose that is often only on one side. Although it’s generally painless, some children may have headaches on the same side as the foreign body. In some cases, there might be blood-tinged discharge or nosebleeds. Children often tell their parents that they’ve put something in their nose, while younger children may just seem cranky.
When the foreign object is a living organism, symptoms may be slightly different and can affect both sides of the nose. Typically, sufferers have a blocked nose, sneeze a lot, have headaches, and have a nasal discharge. It’s also common for these foreign bodies to cause an infection. This can trigger the body’s immune response and increase white blood cell counts. In response to the infection, patients may also have a fever.
- Foul-smelling discharge, typically one-sided
- Headaches on the same side as foreign body
- Blood-tinged discharge or nosebleeds
- Telling a parent about the foreign object
- Blocked nose
- Frequent sneezing
- Headaches
- Nasal discharge
- Infections
- Increase in white blood cells
- Fever
During a physical examination, doctors need good lighting to see the foreign body. The patient should sniff, and the doctor may give a drug to reduce swelling of nasal membranes. The doctor will look into the nose with a specialist instrument. If they suspect a foreign object is alive, they may see widespread destruction of the nasal tissue, cartilage, and bones. This can be accompanied by a nosebleed or a range of discharges from a clear fluid to pus. If a stone-like object, or rhinolith, is blocking the nose, the doctor will see a gray object on the floor of the nose. Additionally, the doctor will check the ear for signs of inflammation and listen to the patient’s lungs for any signs of wheezing. In some cases where the patient is uncooperative, the examination may need to be performed under general anesthetic.
Testing for Nasal Foreign Body
If your doctor suspects you may have swallowed something like a button battery or a small toy, they may not need to take a blood test. However, if the object is living, like a bug for instance, they might check your white blood cell count, as it could be high in this case.
Imaging tests might also be done to see the object, especially if it’s something like a battery or magnet or if the doctor can’t see it clearly during an examination. It’s important to note though that many objects, like plastic toys, often won’t show up on these types of scans.
If there’s a chance the object might have been breathed into the lungs, your doctor will likely want to take a chest x-ray to confirm.
If the doctor thinks a tumor could be causing your symptoms, they may go for more specific and detailed tests such as a CT scan or an MRI. These scans would help them have a better picture of what’s going on.
Treatment Options for Nasal Foreign Body
When a foreign object gets stuck in the nose, it needs to be carefully removed. Doctors use a bright light source, often a headlamp, to see into the nose clearly. At times, it might be necessary to have a parent or caregiver hold the child still during the procedure. If the object is lodged very deep or the child is very distressed, the doctor might use conscious sedation, which is a type of medication that helps the child relax or fall asleep.
Before the procedure, the doctor might apply a topical medication that shrinks the blood vessels in the nose (vasoconstrictor). This can help them see the object better, control any bleeding, and reduce stuffiness. However, this medication is avoided if the object is a button battery, as it could potentially cause leakage of acids.
Doctors have many different tools and methods they can use to remove foreign objects from the nose, such as nasal speculum, various sizes probes, curettes and forceps. Depending on the size and location of the object, they might try to gently pull it out with these tools or use a suction device to draw it downwards. Other removal techniques include the “parent’s kiss” where a parent blows carefully into the child’s mouth to help force the object out, or applying pressure with a special bag-valve-mask device.
In some cases, the doctor might use a technique that involves applying a small amount of glue to the object to pull it out. However, one method that isn’t recommended is rinsing (or irrigating) the nose with fluid, as this can lead to choking or aspiration (accidentally drawing fluid into the lungs).
Removing foreign objects from the nose requires patience, especially when dealing with children. It’s important not to rush or make too many attempts at once. Local anesthesia isn’t usually used, but sedation may be needed for uncooperative children. If the object can’t be easily removed, or if there’s uncertainty about the best approach, the doctor may consult with an ear, nose, and throat specialist (otolaryngologist).
What else can Nasal Foreign Body be?
When a doctor suspects there’s a foreign object in the nasal cavity, they consider several conditions that it could potentially be. These include:
- Sinusitis (infection or inflammation of the sinuses)
- Tumor (an abnormal mass of tissue)
- Polyp (a small growth, typically benign)
- Choanal atresia (a congenital disorder where the back of the nasal passage is blocked)
- Upper respiratory tract infection (like a common cold)
What to expect with Nasal Foreign Body
Normally, patients do not experience long-term effects from foreign objects in the nose.
Possible Complications When Diagnosed with Nasal Foreign Body
Approximately 9% of patients experience complications, such as:
- Nasal septal perforation
- Meningitis
- Sinusitis
- Acute epiglottitis
- Respiratory arrest
- Acute otitis media
- Periorbital cellulitis
- Tetanus
- Nose bleeds
- Nasal obstruction
Some objects inserted into the body, called “radiolucent bodies,” can be hard to detect and can go unnoticed for months or even years. This could be especially dangerous when it comes to small button batteries. These batteries can quickly cause ulcers and tissue death, leading to a hole in the wall separating the nostrils. Another problem is that they can be hard to remove in emergency situations, especially when they are spherical or disk-shaped. The medical team usually needs to try more than once and use different tools.
If the object moves towards the back, it can end up in the respiratory tract, leading to additional health problems.
Preventing Nasal Foreign Body
If you’re a parent of young children, it’s crucial to be mindful of the risk of small objects getting stuck in the nose. When kids are playing with small toys or batteries, it’s important to keep an eye on them to prevent such incidents. Additionally, you might find the “kiss technique” useful. This method can potentially help you dislodge the stuck object from your child’s nose without the need for an emergency department visit.
