- Nasal foreign bodies are commonly encountered in children and present with unilateral nasal discharge. Common objects inserted include beans, beads, pebbles, paper, and eraser tips. - To remove nasal foreign bodies, topical anesthesia and vasoconstriction are applied to shrink nasal tissues. Forceps are then used to grasp and remove hard objects while softer objects can be flushed or suctioned out. - It is important not to push foreign bodies further back or attempt removal without anesthesia. Proper removal prevents potential aspiration into the lungs.

1. Nasal Foreign Bodies
Presentation
Children may admit to parents that they have inserted something into their noses, but
sometimes the history is obscure and the child presents with a purulent unilateral nasal
discharge. Most commonly encountered are beans or other foodstuffs, beads, pebbles,
paper wads, and eraser tips. These foesign bodies usually lodge on the floor of the
anterior or middle third of the nasal cavity. Occasionally, caustic material was sniffed
into the nose or coughed up into the posterior nasopharynx (e.g., a ruptured
tetracycline capsule), the patient will present with much discomfort and tearing, and
inspection will reveal mucous membranes covered with particulate debris.
What to do:
• Explain the procedure beforehand in detail to patient and parents. Explain that it
will be a little uncomfortable, and that aspiration of the foreign body into the
trachea is a real but remote possibility.
• After initial inspection using a nasal speculum and bright light, suction out any
purulent discharge and insert a cotton pledget soaked in 4% cocaine or a
solution of one part phenylephrine (Neo-Synephrine) and one part tetracaine
(Pontocaine) to shrink the nasal mucosa and provide local anesthesia. Be careful
to avoid pushing the foreign body posteriorly. Remove the pledget after
approximately 5-10 minutes.
• If the patient is able to cooperate, have him try to blow his nose to remove the
foreign body. With an infant it is sometimes possible to have the parent blow a
sharp puff into the baby's mouth whild holding the opposite nostril closed to
blow the object out of the nose.
• Before attempting any removal using surgical instruments, a potentially
uncooperative child must be firmly restrained and sedated (see below)
• Alligator forceps should be used to remove cloth, cotton, or paper foreign bodies.
Pebbles, beans, and other hard foreign bodies are more easily grasped using
bayonet forceps or Kelly clamps, or they may be rolled out by getting behind it
using an ear curette, single skin hook, or right angle ear hook. A soft-tipped
hook can be made by bending the tip of a metal-shaft calcium alginate swab

2. (Calgiswab) to a 90 degree angle. An additional approach is to bypass the object
with a Fogarty, biliary or small Foley catheter, passing it superior to the foreign
body, inflating the balloon with approximately 1ml of air and pulling the object
out through the nose.
• Any bleeding can be stopped by reinserting a cotton pledget soaked in the
topical solution used initially.
• To irrigate loose foreign bodies and particulate debris from the nasal cavity and
posterior nasopharynx, simply insert the bulbous nozzle of an irrigation syringe
into one nostril while the patient sits up and forward, ask the patient to close off
the back of his throat by repeating the sound "eng" and flush the irrigating
solution out through the opposite nostril into an emesis basin.
• After the foreign body is removed, inspect the nasal cavity again and check for
additional objects that may have been placed in the patient's nose. Look also for
unsuspected foreign bodies in the ears.
What not to do:
• Do not ignore a unilateral nasal discharge in a child. It must be assumed to be
secondary to a foreign body until proven otherwise.
• Do not push a foreign body down the back of a patient's throat, where it may be
aspirated into the trachea.
• Do not attempt to remove a foreign body from the nose without first using a
topical anesthetic and vasoconstrictor.
Discussion
The mucous membrane lining the nasal cavity allows you the tactical advantages of
vasoconstriction and topical anesthesia. In cases where patients have unsuccessfully
attempted to blow foreign bodies out of their noses, they may be successful after
instillation of an anesthetic vasoconstriction solution. If a patient swallows a foreign
body that has been pushed back into the nasopharynx, this is usually harmless and the
the patient and parents can be reassured. If the object is aspirated into the
tracheobronchial tree, it may produce coughing and wheezing and bronchoscopy under
anesthesia will be required for retrieval. Button batteries can cause serious local
damage and should be removed quickly.