Diagnosis and management of intranasal foreign bodies
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Department of Otolaryngology, Head and Neck Surgery and Pediatrics
- Lewis Katz School of Medicine at Temple University
- Aderonke Ojo, MD
Aderonke Ojo, MD
- Associate Professor of Pediatric Emergency Medicine
- Baylor College of Medicine
- Section Editor
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Intranasal foreign bodies (FBs) occur most commonly in young children and consist of a variety of inorganic and organic objects. In most instances, the patient is asymptomatic. The majority of intranasal FBs are removed at initial presentation and do not require referral to an otolaryngologist. Button batteries and paired disc magnets can cause serious damage to nasal structures and merit urgent removal.
The diagnosis and management of intranasal FBs is presented here. FBs of the outer ear, airway, and digestive tract are discussed separately:
- Chinski A, Foltra F, Gregori D, et al.. Foreign bodies in children: A comparison between Argentina and Europe. Int J Pediatr Otorhinolaryngol 2012; [Epub ahead of print].
- François M, Hamrioui R, Narcy P. Nasal foreign bodies in children. Eur Arch Otorhinolaryngol 1998; 255:132.
- Celenk F, Gokcen C, Celenk N, et al. Association between the self-insertion of nasal and aural foreign bodies and attention-deficit/hyperactivity disorder in children. Int J Pediatr Otorhinolaryngol 2013; 77:1291.
- Claudet I, Salanne S, Debuisson C, et al. [Nasal foreign body in infants]. Arch Pediatr 2009; 16:1245.
- Chinski A, Foltran F, Gregori D, et al. Nasal foreign bodies: the experience of the Buenos Aires pediatric otolaryngology clinic. Pediatr Int 2011; 53:90.
- Figueiredo RR, Azevedo AA, Kós AO, Tomita S. Nasal foreign bodies: description of types and complications in 420 cases. Braz J Otorhinolaryngol 2006; 72:18.
- Ogunleye AO, Sogebi OA. Nasal foreign bodies in the African children. Afr J Med Med Sci 2004; 33:225.
- Litovitz T, Whitaker N, Clark L, et al. Emerging battery-ingestion hazard: clinical implications. Pediatrics 2010; 125:1168.
- Guidera AK, Stegehuis HR. Button batteries: the worst case scenario in nasal foreign bodies. N Z Med J 2010; 123:68.
- Jonas NE, Meyer E. Magnetic foreign body on the nasal septum. S Afr J Surg 2007; 45:151.
- Starke L. Easy removal of nasal magnets. Pediatr Emerg Care 2005; 21:598.
- Greenberg M, Magit A. Magnetic nasal foreign bodies in a 9-year-old male: opposites attract when it comes to nasal foreign bodies. Int J Pediatr Otorhinolaryngol 2005; 69:981.
- Yeh B, Roberson JR. Nasal magnetic foreign body: a sticky topic. J Emerg Med 2012; 43:319.
- Shermetaro C, Charnesky M. Pediatric nasal septal perforation secondary to magnet misuse: a case report. Ear Nose Throat J 2007; 86:675.
- Heim SW, Maughan KL. Foreign bodies in the ear, nose, and throat. Am Fam Physician 2007; 76:1185.
- Kalan A, Tariq M. Foreign bodies in the nasal cavities: a comprehensive review of the aetiology, diagnostic pointers, and therapeutic measures. Postgrad Med J 2000; 76:484.
- Tong MC, Van Hasselt CA, Woo JK. The hazards of button batteries in the nose. J Otolaryngol 1992; 21:458.
- Palmer O, Natarajan B, Johnstone A, Sheikh S. Button battery in the nose--an unusual foreign body. J Laryngol Otol 1994; 108:871.
- Dane S, Smally AJ, Peredy TR. A truly emergent problem: button battery in the nose. Acad Emerg Med 2000; 7:204.
- Watanabe K, Hatano GY, Aoki H, Okubo K. The necessity of simple X-ray examination: a case report of button battery migration into the nasal cavity. Pediatr Emerg Care 2013; 29:209.
- Gregori D, Salerni L, Scarinzi C, et al. Foreign bodies in the nose causing complications and requiring hospitalization in children 0-14 age: results from the European survey of foreign bodies injuries study. Rhinology 2008; 46:28.
- Glynn F, Amin M, Kinsella J. Nasal foreign bodies in children: should they have a plain radiograph in the accident and emergency? Pediatr Emerg Care 2008; 24:217.
- Ozdemir S, Akbas Y, Görgülü O, et al. Rhinolithiasis: review of 21 cases. Am J Rhinol Allergy 2010; 24:136.
- Qureshi AA, Lowe DA, McKiernan DC. The origin of bronchial foreign bodies: a retrospective study and literature review. Eur Arch Otorhinolaryngol 2009; 266:1645.
- Mishra P, Bhakta P, Kumar S, et al. Sudden near-fatal tracheal aspiration of an undiagnosed nasal foreign body in a small child. Emerg Med Australas 2011; 23:776.
- Tong MC, Ying SY, van Hasselt CA. Nasal foreign bodies in children. Int J Pediatr Otorhinolaryngol 1996; 35:207.
- Kadish HA, Corneli HM. Removal of nasal foreign bodies in the pediatric population. Am J Emerg Med 1997; 15:54.
- Mackle T, Conlon B. Foreign bodies of the nose and ears in children. Should these be managed in the accident and emergency setting? Int J Pediatr Otorhinolaryngol 2006; 70:425.
- Lichenstein R, Giudice EL. Nasal wash technique for nasal foreign body removal. Pediatr Emerg Care 2000; 16:59.
- Handler SD. Nasal wash technique for nasal foreign body removal. Pediatr Emerg Care 2000; 16:307.
- Backlin SA. Positive-pressure technique for nasal foreign body removal in children. Ann Emerg Med 1995; 25:554.
- Kiger JR, Brenkert TE, Losek JD. Nasal foreign body removal in children. Pediatr Emerg Care 2008; 24:785.
- Botma M, Bader R, Kubba H. 'A parent's kiss': evaluating an unusual method for removing nasal foreign bodies in children. J Laryngol Otol 2000; 114:598.
- Finkelstein JA. Oral Ambu-bag insufflation to remove unilateral nasal foreign bodies. Am J Emerg Med 1996; 14:57.
- Cook S, Burton M, Glasziou P. Efficacy and safety of the "mother's kiss" technique: a systematic review of case reports and case series. CMAJ 2012; 184:E904.
- Navitsky RC, Beamsley A, McLaughlin S. Nasal positive-pressure technique for nasal foreign body removal in children. Am J Emerg Med 2002; 20:103.
- Hills RW, Brown JC, Brownstein D. Barotrauma: a complication of positive pressure for nasal foreign body removal in a pediatric patient. Ann Emerg Med 2008; 52:623.
- Kavanagh KT, Litovitz T. Miniature battery foreign bodies in auditory and nasal cavities. JAMA 1986; 255:1470.
- Brown L, Denmark TK, Wittlake WA, et al. Procedural sedation use in the ED: management of pediatric ear and nose foreign bodies. Am J Emerg Med 2004; 22:310.
- Hanson RM, Stephens M. Cyanoacrylate-assisted foreign body removal from the ear and nose in children. J Paediatr Child Health 1994; 30:77.
- Gomes CC, Sakano E, Lucchezi MC, Porto PR. Button battery as a foreign body in the nasal cavities. Special aspects. Rhinology 1994; 32:98.
- Friedman EM. VIDEOS IN CLINICAL MEDICINE. Removal of Foreign Bodies from the Ear and Nose. N Engl J Med 2016; 374:e7.
- CLINICAL ANATOMY
- CLINICAL MANIFESTATIONS
- DIFFERENTIAL DIAGNOSIS
- FOREIGN BODY REMOVAL
- Indications for subspecialty consultation or referral
- - Positive pressure techniques
- - Instrumentation
- - Magnet removal
- INFORMATION FOR PATIENTS
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS