Foreign bodies in the nose

Last updated: August 31, 2023

Summarytoggle arrow icon

Foreign bodies (FBs) are typically inserted in the nose by young children or adults with developmental or psychiatric disorders. Inanimate objects such as jewelry, food, toys, and pebbles are most commonly found, while animate objects such as insects are less common. Patients may initially be asymptomatic, presenting with only a history of a witnessed FB insertion. Patients with an unwitnessed FB insertion typically present late with symptoms of unilateral nasal obstruction, purulent discharge, and epistaxis. Foreign bodies in the nose are usually diagnosed clinically with anterior rhinoscopy. All nasal FBs require removal and a variety of techniques can be used (e.g., positive pressure, instrumentation). Sedation and specialist consultation may be required for complex cases. Complications include infection and foreign body aspiration.

Epidemiologytoggle arrow icon

  • Occurs most commonly in children; peak age 1–5 years [1][2]
  • Can occur in adults with developmental and/or psychiatric disorders [3]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

  • Inanimate objects (most common) [4]
    • Jewelry (e.g., beads, pearls)
    • Small toys
    • Food (e.g., beans, nuts, corn kernels, grapes)
    • Pebbles
    • Others: paper, magnets, button batteries
  • Animate objects (less common): E.g., insect or larvae infestation can occur in tropical climates. [3]

Clinical featurestoggle arrow icon

Patients may present with few or no symptoms if they are brought in by a caregiver shortly after a witnessed FB insertion.

Consider nasal FBs in nonverbal patients with unexplained upper respiratory symptoms, as the insertion may not have been observed by their caregiver. [5]

Diagnosticstoggle arrow icon

Evaluate for foreign bodies in the ear and foreign body aspiration in at-risk patients.

Evaluate for nasal FB in patients with unilateral nasal symptoms to avoid a misdiagnosis of rhinitis or sinusitis. [5]

Differential diagnosestoggle arrow icon

See “Differential diagnosis of nasal congestion.”

The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

General principles [3][6][7]

  • Removal is indicated for all confirmed nasal FBs.
    • Consult ENT for: [6]
      • FBs with a high risk of tissue necrosis: e.g., button batteries, multiple magnets
      • Low likelihood of successful removal: e.g., poor visualization, limited patient cooperation
      • High risk of traumatic removal: e.g., sharp or penetrating FBs, impacted FBs with surrounding inflammation, infection, or granulation tissue [5]
      • Multiple unsuccessful attempts [7]
      • Suspected neoplasm [3][5]
    • For all other cases, attempt removal in a primary care setting. [8]
  • Noninvasive techniques (e.g., positive pressure techniques) are preferred when possible.
  • Troubleshooting techniques (e.g., topical anesthetic, procedural sedation) may aid in FB removal.
  • Operative removal under general anesthesia is considered a last resort.

Bedside removal techniques [3][6][7]

The preferred removal technique is based on the FB (e.g., size, location) and patient characteristics (e.g., age, expected degree of cooperation) with a preference for noninvasive techniques (e.g., positive pressure techniques).

Positive pressure techniques

  • Self-administered: Ask the patient to occlude the unaffected nostril and then blow their nose.
  • “Parent's kiss” technique: Ask a parent or guardian to occlude the patient's unaffected nostril and provide mouth-to-mouth positive pressure.
  • Bag-mask ventilation (BMV) technique: Occlude the patient's affected nostril and apply positive pressure using a well-sealed BMV device over the mouth.

Instrumentation techniques

  • Forceps
    • Alligator or nasal packing forceps are used to grasp and retrieve the FB.
    • Suitable for soft FBs that can be grasped without disintegrating
  • Angled blunt probe or curette
    • A probe is passed behind the FB, rotated to hook the object, and then withdrawn.
    • Suitable for solid FBs and cooperative patients
  • Balloon-tipped catheter
    • A catheter is passed behind the FB, the end balloon is inflated (e.g., 1 mL), and the catheter is then withdrawn.
    • Suitable for solid FBs
  • Suction-based technique
    • A catheter connected to low wall suction is applied directly to the object.
    • Suitable for FBs that are loose, made up of organic matter, or smooth and round
  • Glue-based technique
    • Cyanoacrylate glue is applied to the end of a swab, attached to the object for ≥ 60 seconds, then withdrawn.
    • Suitable for loose solid FBs and cooperative patients

Instrument-assisted and glue-based techniques can cause injury in uncooperative patients.

Avoid irrigation and probing that could lead to foreign body aspiration. Keep airway management equipment nearby during removal.

Troubleshooting [3][6][7]

The following may facilitate a successful removal and can be considered on a case-by-case basis:

Anticipate epistaxis after removal and be ready to treat with direct pressure. [6]

Complicationstoggle arrow icon

Paired magnets and button batteries can lead to tissue necrosis and nasal septal perforation. [6]

We list the most important complications. The selection is not exhaustive.

Referencestoggle arrow icon

  1. François M, Hamrioui R, Narcy P. Nasal foreign bodies in children.. Eur Arch Otorhinolaryngol. 1998; 255 (3): p.132-4.doi: 10.1007/s004050050028 . | Open in Read by QxMD
  2. Morris S, Osborne M, McDermott A. Will children ever learn? Removal of nasal and aural foreign bodies: a study of hospital episode statistics. Ann R Coll Surg Engl. 2018; 100 (8): p.632-634.doi: 10.1308/rcsann.2018.0115 . | Open in Read by QxMD
  3. Oyama LC. Foreign Bodies of the Ear, Nose and Throat. Emerg Med Clin North Am. 2019; 37 (1): p.121-130.doi: 10.1016/j.emc.2018.09.009 . | Open in Read by QxMD
  4. Svider PF, Sheyn A, Folbe E et al. How did that get there? A population-based analysis of nasal foreign bodies. Int Forum Allergy Rhinol. 2014; 4 (11): p.944-949.doi: 10.1002/alr.21396 . | Open in Read by QxMD
  5. Heim SW, Maughan KL. Foreign bodies in the ear, nose, and throat. Am Fam Physician. 2007; 76 (8): p.1185-9.
  6. Wilson JL. Primary Care Removal of Fishhooks, Rings, and Foreign Bodies from the Ear, Nose, and Superficial Eye and Conjunctiva. Prim Care. 2021; 48 (4): p.655-676.doi: 10.1016/j.pop.2021.07.005 . | Open in Read by QxMD
  7. Ng TT, Nasserallah M. The art of removing nasal foreign bodies. Open Access Emerg Med. 2017; Volume 9: p.107-112.doi: 10.2147/oaem.s150503 . | Open in Read by QxMD
  8. Jungbauer WN, Shih M, Nguyen SA, Clemmens CS. Comparison of pediatric nasal foreign body removal by care setting: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol. 2022; 158: p.111162.doi: 10.1016/j.ijporl.2022.111162 . | Open in Read by QxMD
  9. Brown L, Denmark TK, Wittlake WA, Vargas EJ, Watson T, Crabb JW. Procedural sedation use in the ED: management of pediatric ear and nose foreign bodies. Am J Emerg Med. 2004; 22 (4): p.310-314.doi: 10.1016/j.ajem.2004.04.013 . | Open in Read by QxMD
  10. van der Veen J, Thorne S. Bacterial meningitis: a rare complication of an unrecognised nasal foreign body in a child. BMJ Case Reports. 2017: p.bcr2015209577.doi: 10.1136/bcr-2015-209577 . | Open in Read by QxMD

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