Nasal Foreign Body Removal: A Common But Challenging Emergency In Children

This is a real incident. A 4 year old child, whose parents are tailors was brought to a community health care center with a shirt button inserted accidentally into the left nasal cavity while playing at home. The father tried to remove it himself by trying to squeeze the nose and then brought him to the hospital. The child was in pain and started to cry and his nose started to bleed. To confirm if the button went into the stomach, an x-ray of the face was taken. The child had fever from an infection in the nose. The child still had the button in the nose that had to be removed under anesthesia and then was admitted to control the infection.

There have been over 50 peer reviewed articles on the epidemiology and management techniques for foreign bodies impacted within the nasal cavities in the last 10 years. The latest articles have been about novel techniques for removal of nasal foreign bodies (NFB’S). On conducting structured clinical observations with multidisciplinary teams this problem is frequently encountered and in some cases has lead to faulty removal with surgical consequences.

The Problem and the Reasons:

• Children between 2-6 years are considered to be the most vulnerable victims of impacted foreign objects in their nasal cavities.

• The cause speculated in literature as to why this happens is probably because of their curiosity to play with tiny objects and explore the nasal cavity by inserting things inside in unsupervised surroundings which is much the case in low to middle income families with both working parents.

• Many times an allergic process in the nose creates the sense of itching and children often use objects that they can reach easily to insert into the nasal cavities as an attempt to relieve their distress.

• Though such impactions are seen in older populations they are believed to be because of mental retardation or due to morbid psychiatric illnesses.

Removal techniques

• The removal techniques have been a topic of debate since the existence of mankind and many articles have discussed the pros and cons of various techniques.

• Until today there seems to be no standardized tool or method to remove these impacted foreign bodies from the nasal cavities.

• Though some may claim the foreign body hook is the most accepted solution, it is however not designed exclusively for the nasal cavity.

• It is an effective tool if the child is stabilized well while performing the removal.

• It is not very easy to use either and is used only by a few ENT surgeons.

• Some believe in using the eustachian tube catheter which was originally created to catheterise the eustachian tube, an opening behind the nasal cavity that connects to the middle ear.

• Again, only few ENT surgeons prefer this method and is heavily skill dependent.

Incidence of NFB Removal Cases:It is important to note that an average of 25 cases per month were noted in all types of hospitals ranging from private clinical to general tertiary hospitals. A pattern noted frequently was lower number of cases in urban private hospitals/clinics (10 -12 cases/month) whereas higher cases in rural government hospitals and clinics (up to 40 cases/month).

Why are there so many cases of nasal foreign body (based on extensive publications) insertion?

There are many theories to address this question and some of which believe that the reason behind is:

As the low income families are turning to middle income families with an increase in the number of working parents, there may be a decline in the amount of parent supervision given to children.

Who Typically Removes These Nasal Foreign Bodies?

Nasal foreign body removal is usually done by ENT surgeons. However many cases are attempted by paediatricians and general practitioners also.

Where does the Problem Actually Lie?

Based on the discussion it may be inferred that in spite of a significantly large number of cases that need nasal foreign body removal, the ENT surgeons are comfortable in removing these successfully. Very few cases nowadays actually need removal under general anaesthesia (<5%). The problem seems to be present with paediatric age groups. The need for a simplified and standardized NFB removal tool for this segment of patients will probably help solve this problem more effectively.

Consult an ENT otolaryngologist online for queries regarding foreign body removal from nose --> https://www.icliniq.com/ask-a-doctor-online/ENT-Otolaryngologist