Foreign Body

The common symptoms of foreign body in nose would be smelly nasal discharge especially unilateral. Children might present with the history of epistaxis or symptoms of sinusitis. Eye witness of children inserting  something into their nose or missing parts from toy after children play with it might be a very helpful information.

Foreign bodies can be classified into two groups which are inorganic and organic. Inorganic materials are typically plastic or metal in the form of beads and small parts of toys. These materials are often inert and patient usually remains asymptomatic and may be discovered incidentally. Meanwhile organic foreign bodies such as rubber, wood and food tend to be more irritating to the nasal mucosa and may produce earlier symptoms.

The incidence of the foreign body in nose started after 9 months of age when the children started to develop their pincer grip. However, the higher incidence is among the boy at the age between 2 to 5 year old. Commonly it involved one side of the nose and right side is twice the incidence of left side. It is not uncommon to see multiple foreign body in not and even both nostrils.

Foreign body in nose might cause mucosal irritation and inflammation and subsequently causing infection and extension to the adjacent structures.Complication such as sinusitis, septal perforation, meningitis and acute epiglotitis.

Special Attention needed if the foreign body inserted into the nose is button batteries. It should be removed as soon as possible within 4 hours as the leaking of chemical from the battery could cause an extensive destructive effect. Chemical burn, ulceration and then liquefaction necrosis would lead to extensive mucosa necrosis and also septal perforation. Irrigation should be avoided to prevent the spread of the chemical to the surrounding tissue.

Foreign body removal could be done as outpatient basis or under general anaesthesia. Jobson Horn and hooked probes can be used to remove the objects that is difficult to be grasped. Meanwhile, Tilley’s and crocodile forceps could be used if the object is easily graspable. Suction catheter could be used in smooth and spherical objects. Alot of the time the foreign body could be removed in clinic setting except in certain circumstances.