Symptoms
Affected infants rub their noses, point, pick their nostrils, and may experience discomfort or pain. An asymptomatic course is also possible, and the foreign bodies may remain undetected in the nose for hours, days, weeks, and even years (!). Over time, depending on the object, complications may develop, such as inflammation, an unpleasant odor, secretions, a purulent discharge, nosebleeds, sinusitis, perforations, ulcerations, and necrosis. Large objects can interfere with nasal breathing, and dangerous foreign bodies can cause injury, bleeding, and severe pain.
Causes
Some infants develop the unfortunate habit of inserting small objects into their nostrils, such as Lego pieces, button batteries, pebbles, beads, toy parts, jewelry, or foods such as rice, nuts, beans, and bread. A distinction is made between organic and inorganic objects. Children up to the age of five may be affected. In adults, foreign bodies in the nose are less common, but can also occur. For example, superglue has also been mistaken for nasal ointment. The objects can exert local pressure in the nose, cause injury, release chemicals, and cause irritation and inflammatory reactions.
Diagnosis
At home, the nasal cavity can be inspected with a small LED flashlight. This is done by gently pushing the tip of the nose upward. It must be noted that foreign bodies can reach far back. In medical treatment, imaging techniques can also be used in addition. A nasal speculum allows examination of the inside of the nose and insertion of instruments.
Treatment
Immediate medical treatment is required for sharp or pointed objects, such as broken glass, small screws, or needles (medical emergency). Also, if breathing is obstructed on both sides, contact a health care provider immediately. Button batteries and magnets are considered harmful and should be removed as soon as possible. The therapy depends on the type, shape, material and size of the foreign body. Basically, the objects can get stuck locally, pass out the front of the nostrils, or slide backward into the esophagus. In the intestine, they are excreted or digested. As a complication, foreign body aspiration is possible. In this case, the object enters the trachea and lungs and must be removed under specialist treatment. Food pieces have the advantage that they usually dissolve or at least soften, making removal easier.
Removal of foreign bodies
The child should sit upright on a parent’s lap during removal. The head and extremities are held in place. For removal of foreign bodies, we always recommend a visit to the doctor because of the risk of aspiration and injury. Sometimes parents are successful in removing the foreign bodies themselves. The following are some methods. A nasal aspirator, otherwise used to treat a cold, can be used to clear the nose and possibly suck the foreign body out. Moistening nasal sprays (e.g., with sea water, Ems salt, saline solutions) can be used repeatedly to moisten and soften. This allows the foreign body to move more easily. The sprays may also trigger sneezing. Irrigation solutions are also available that are injected into the unaffected nostril. The solution exits the other side ideally along with the foreign body. This method is also performed with a syringe at the doctor’s office. Decongestant nasal sprays with active ingredients such as xylometazoline or oxymetazoline decongest the mucosa, inhibit secretion, and thus increase the likelihood that the foreign body will pass out of the nasal opening. These sprays may be used acutely only once, and products suitable for young children must be used. There is criticism in the literature that the nasal sprays may increase the risk for aspiration. With little pepper in the nose, sneezing can be induced. Fingers can be used to gently massage the nose toward the orifices. In the literature, another method is described and recommended, which the parents can perform, the so-called “parent’s kiss”.In this kissing technique, the lips of the mother or father enclose the child’s mouth and it is blown once forcefully. At the same time, the nostril, which is not affected, is held shut with a finger. Older children can blow their own nose and should also hold the opposite nostril shut. The use of metal tweezers or other tools is not suitable due to the risk of injury. If these measures do not lead to the desired result, removal by a specialist or hospital is indicated. The responsible specialists are ear, nose and throat (ENT) physicians. Suitable instruments are available, such as foreign body forceps (alligator), curettes, rounded forceps, balloon catheters, and suction pumps and irrigation. Sometimes some superglue on a stick is also used. Medical treatment may include sedation, local anesthesia, or anesthesia.
Prevention
- Remove small objects from all rooms to which the child has access (e.g., nursery, playroom).
- Monitor the child and pay attention when eating.
- When visiting another household, watch for small objects.
- Repeatedly forbid the child to shove foreign objects up his nose.