NOSE - Foreign Body Nose

Introduction:

Foreign body in nose can present acutely, sub-acutely or many years later in adulthood.

Occurrence of foreign body in nose:

  • Age: Usually found in children between 2-5 years of age.
  • Site: Foreign bodies commonly lodge between septum and inferior turbinate or between the septum and middle turbinate if they are pushed deep into the nose.

What are the different types of foreign bodies in nose?

  • Organic foreign bodies: Tissue paper, seeds, sponge, peas etc. They provoke an intense inflammatory reaction from the nasal mucosa.
  • Inorganic Material: Beads, button, rubbers, wooden pieces require careful removal.
  • Battery: Button cell battery inserted in the nasal cavity requires urgent examination under anaesthesia. Leakage from the battery can result in corrosive burns and destruction of the nasal septum.

What are the clinical features of foreign body in nose?

Common symptoms of foreign body in nose:

  1. Early:
    • Subacute presentation: Subacute presentation is with a foul smelling unilateral nasal discharge not responding to treatment
    • Excoriation of affected nares
  2. Late Presentation:
    • Retained foreign bodies in adults present as unilateral nasal congestion and discharge
    • Sinusitis
    • Rhinolith formation, due to deposition of calcium and magnesium salts around the foreign body.

What investigations are required in cases of nasal foreign body?

  • Nasal foreign bodies are usually visible on anterior rhinoscopy.
  • CT Scan may demonstrate a radio-opaque or impacted foreign object
  • X-ray paranasal sinuses may reveal pan-sinusitis.

How are nasal foreign body removed?

  • Most subacute foreign bodies are removed as an OPD procedure by inserting a vectis or a wax hook behind the foreign body and sweeping it along the floor of the nose.
  • Foreign bodies which are long standing must be extracted under general anaesthesia as they are impacted and can cause some amount of bleeding and pain.
  • FESS may be required for embedded foreign bodies.



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