Residual nasal foreign body – a case report and review of literature

Nasal foreign bodies in children are common complaints encountered by pediatric otolaryngologists. We investigated clinical features, diagnosis, and treatment of nasal foreign bodies in children in a Chinese metro area.Six hundred sixty eight children with nasal foreign bodies presented to Shenzhen Children's Hospital, diagnosed and treated by the authors were enrolled from January 2016 to October 2019, causes for medical consultation, age, sex, duration, types, locations, removal, and complications were recorded and analyzed.Nasal foreign bodies were common in children between 1 and 5 years of ages (96.8%). The right nasal cavity (61.4%) was the most common site for foreign body insertion (61.4%). Most of the children (89.4%) presented for a complaint of nasal discomfort or foreign body insertion themselves, or for foreign body impaction discovered by the caregivers. Most of the foreign bodies (85.0%) were discovered within 1 day. The most nasal foreign bodies were the whole toys and toy parts (34.1%). The majority of nasal foreign bodies (99.1%) located in the antero-inferior portion of the nasal cavities and could be removed with simple instruments. The occurrence of complications in nasal foreign bodies (10.2%) was not common.The present study objectively exhibited clinical features, diagnosis, and treatment of nasal foreign bodies in a Chinese metro area.

To evaluate signalment, clinical presentation, location and type of nasal foreign bodies identified by rhinoscopy in dogs. We retrospectively reviewed medical records from dogs that presented for consultation between April 2012 and June 2019 and were diagnosed with nasal foreign body via rhinoscopy. Forty-two dogs met the study's inclusion criteria. Thirty (71.4%; 30/42) were purebreds. Males accounted for 59.5% (25/42) of cases. The median age was 4.0 years old and 76.2% (32/42) were dogs up to 7 years of age. Mean bodyweight was 21.8kg and dogs weighing more than 10kg were overrepresented (78.6%; 33/42). Sneezing occurred in 78.6% (33/42) of cases. Foreign body retrieval was achieved by rhinoscopy in all cases. The foreign body was extracted from the right nasal cavity in 52.4% (22/42) of cases and from the left one in 42.9% (18/42). Two dogs (4.8%; 2/42) presented with one foreign body in each nasal cavity. Most nasal cavity foreign bodies (90.5%; 38/42) were grass awns. Three (7.2%; 3/42) were mineral and one (1/42) was fabric. Follow-up was documented for 35 patients, of which 97.1% (34/35) experienced resolution of clinical signs. Seven cases (16.7%; 7/42) were lost to follow-up. Nasal foreign bodies were more common in dogs up to 7 years of age and heavier than 10kg. Sneezing was the primary clinical sign. The vast majority of foreign bodies were grass awns and rhinoscopy was an effective means of nasal cavity foreign body retrieval.

Introduction Foreign body removal is a common reason for children to attend the emergency department. Generally, aural and nasal foreign bodies are not associated with immediate morbidity unless they are button batteries. There can be consequences of migration and removal. Methods Hospital Episode Statistics for 2010-2016 were used to calculate the number of nasal and aural foreign bodies that have been removed in hospital. Data for adults and children have been compared. Results 8752 nasal and 17,325 aural foreign bodies have been removed from adults and children over the course of 6 years. Children were responsible for 95% of the 8353 nasal and 85% of the 14,875 aural foreign body presentations. Children aged 1-4 years are most at risk of injury. Conclusion Children are more likely to present to hospital than adults with a foreign body in the ear or nose. Aural bodies were more likely to need removal in hospital for both populations. Authors believe that these require identification and removal by an ear, nose and throat specialist to prevent morbidity. The overall number of procedures performed annually in children has not reduced over the study period; an average of 1218 nasal and 2479 aural foreign body removals are performed each year with an annual cost of £2,880,148 to NHS England.

The effects of an incorporated button battery as a nasal foreign body with regard to the endonasal structures are serious. The following case report will illustrate this on the case of a 4?-year old boy. The acute treatment consisted of the removal of the battery and the debridement of the necroses. Already these measures required considerable medical expenditure. Reconstructive measures which may be needed in the future, will also require a lot of resources. Button batteries as incorporated nasal foreign bodies can lead to severe damage to the endonasal mucoperichondrium. It can lead to necrosis of the nasal septum cartilage and to consecutive nasal septum perforation. Based on these experiences and a review of literature, the conclusions should be drawn that an incorporated button battery should be considered as an ENT emergency case and the immediate removal of the foreign body should be striven for.

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Nasal foreign body impaction is a common problem in paediatric population. Children are more affected because they have tendency to put anything in the nose or by their playmates. This study is about the various radio opaque nasal foreign bodies we encountered and their management. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A retrospective study between January 2013 - January 2015, at Institute of child health/Madras Medical College, Chennai, was done in paediatric patients, who have accidently inserted the radio opaque foreign body in their nostrils. The case record were analysed for the nature of radio opaque nasal foreign body, the symptoms, complications encountered. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">There were 11 patients with radio opaque foreign body in our study. The most common age group was between 1 to 5 years 7 patients were in this age group. The type of foreign was button battery were 5 in number, safety pins 4, marble 1, bolt 1. All the patients were brought to hospital within 4 hours of insertion. We did not encounter any complications while removal of the nasal foreign bodies. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Nasal foreign bodies are a common problem among children’s. The foreign body retrieval can be posing a great challenge to the otorhinolaryngologists. The radio opaque foreign body especially button battery, if not removed may lead to serious complications like septal perforation.</span></p><p class="abstract"> </p>

The treatment of nasal foreign bodies involves safe and reliable removal. Few reports have investigated the relationship between equipment and the incidence of complications. This retrospective study included 300 patients with nasal foreign bodies (average: 3.28 years, interquartile range: 2-4 years). Patients' background, characteristics of nasal foreign body, equipment to remove the nasal foreign body, and complications were obtained from medical records. Statistical analysis was performed using Pearson's chi-square test for associated factors and the incidence of epistaxis among the complications. Nasal foreign bodies were found and removed in 256 patients. Forceps, hooks, suction, modified paper clips, and cotton swabs were mainly used to remove the nasal foreign bodies. Epistaxis due to the removal procedure was observed in 26 patients. The occurrence of epistaxis differed depending on the equipment (p=0.077) and was less frequent in suction and paper clips than in forceps (p < 0.05 and p=0.077). Epistaxis was not observed when a cotton swab was used. Aspiration and septal perforation were not observed. A statistical relationship was not detected between the hardness of foreign bodies and the occurrence of epistaxis (p=0.251). The incidence of epistaxis was higher in cases nasal foreign bodies remained for 1 day and over than in cases foreign bodies were removed within 1 day (p < 0.05). This study revealed that suction, modified paper clips, and cotton swabs could be beneficial options for minimizing complications in the removal of nasal foreign bodies. 4 Laryngoscope, 133:2553-2557, 2023.

Foreign bodies (FBs) in the nasal cavity are commonly encountered in otorhinolaryngology. This retrospective study was conducted between January 2009 and December 2020. The nasal FB frequencies were investigated according to age and sex. The type, shape, and location of the FBs, onset, and clinical features were obtained. In a total of 1228 cases, the average age was 3.9 ± 5.7 years. We found a higher incidence in patients 2–4 years old. The most frequent nasal FBs were beads (24.0%), toys/plastics (17.8%), and beans/corn (15.8%). However, there were some differences in the nasal FB types according to the age group. There was no difference in the location of the nasal FBs according to age group, but nasal FBs were found more frequently in the right nasal cavity in the 1–3-years-old groups. Most patients (97.5%) visited the hospital the same day when the nasal FB insertion was suspected, and most were asymptomatic. After the removal of the nasal FBs, most patients were free of complications. Of the nine cases involving button batteries, septal perforation was observed in two patients who visited the hospital one or two days after the FB insertion. There were specific age-based characteristics of the nasal FBs that may serve as a basis for specific precautions.

The purpose of this study was to calculate nationwide incidence of emergency department (ED) visits for nasal foreign bodies, identify the most frequently encountered consumer products, and evaluate outcomes and demographic trends. The Nationwide Electronic Injury Surveillance System (NEISS) was evaluated for ED visits related to nasal foreign bodies for the most recent 5-year span available. Nationwide incidence was calculated, and the most frequent foreign bodies were identified and organized by demographics including age and gender. A total of 6418 entries extrapolated to an estimated 198,566 ED visits nationwide were found. Out of individual case entries evaluated, median patient age was 3 years, and 42.7% of patients were male. Ninety-six percent (96.4%) of patients were released after examination/treatment. Jewelry beads comprised a plurality of nasal foreign bodies, followed by paper products and toys. Patients with nasal foreign bodies involving toys, building sets, pens/pencils, batteries, coins, and nails/screws were predominantly male, whereas patients with nasal foreign bodies involving jewelry, paper products, and buttons were predominantly female. Jewelry was the most common item for patients in most age groups; age-specific differences in the composition of remaining nasal foreign bodies were noted. A variety of consumer products carry inherent risks for becoming nasal foreign bodies, with nearly 200,000 ED visits over a 5-year period. Jewelry beads, paper products, and toys were the most common products noted. Speedy recognition and retrieval of these items and other objects noted is imperative for avoidance of deleterious sequelae. Demographic-specific trends noted and organized by age and gender may be an invaluable adjunct for patient history-taking and clinical examination.

BACKGROUND: Nasal foreign bodies are common domestic accidents in children. They can constitute a great challenge and management may require great skill. However, seldom does the Otolaryngologist keep track of the number and kinds of the foreign bodies he encounters. OBJECTIVE: To evaluate cases of nasal foreign bodies among children managed in Otorhinolaryngology Department of the University of Calabar Teaching Hospital, Nigeria. MATERIALS AND METHODS: A retrospective study of 215 Cases of paediatric nasal foreign bodies seen and managed in the Otorhinolaryngology Department of the University of Calabar Teaching Hospital from January 2015 to December 2018. Maximum age was 14years.The case notes of all children diagnosed with nasal foreign bodies within the period under review, from ENT Clinic, Ward and Children emergency Room were reviewed as related to age, gender, and type of foreign bodies, category of doctors, methods of removal and complications. Data were analysed and presented in descriptive, tabular and chart forms. RESULTS: Of the 215 children, 43.7% were males and 56.3% females. The age range was 0 - 14 years, with a male: female ratio of 1:1.35.The peak age range at which nasal foreign bodies were found was 0 - 4 years (87%) and the least frequent age bracket was 10 - 14years (1.4%). Most of the children were asymptomatic (60%), and others had unilateral foul-smelling nasal discharge (40%). The most common foreign body were beads (34.9%), followed by seeds (23.2%). Most presentations were within one day (90%), followed by one week (7%). Most foreign bodies (59.5%) were inserted into the right nostril, and 40.5% into the left. No bilateral insertion was observed. Most of the foreign bodies (80%) were mechanically extracted with Jobson-Horne’s probes without general anaesthesia. Mainly Registrars did most removals 65% while 25% were by Senior Registrars. Mild epistaxis was a complication in 5% of cases. CONCLUSION: Nasal foreign bodies are common in Calabar. The most frequently observed foreign bodies were beads and seeds. Therefore, public health education is needed for parents and caregivers.

Aural and nasal foreign bodies in children – Epidemiology and correlation with hyperkinetic disorders, developmental disorders and congenital malformations

Removal of nasal foreign bodies in the pediatric population

SummaryNasal cavities foreign bodies are common accidents in children, sometimes leading, in accordance with the literature, to complications such as epistaxis and bronchoaspiration. Diagnosis is often made with anterior rhinoscopy, but sometimes nasal fibroendoscopy and imaging may be useful.AimTo evaluate 420 cases of nasal foreign bodies removed in ENT Service of Souza Aguiar Hospital, Rio de Janeiro, as related to sex, age, type of foreign body and complications.Materials and method420 cases of nasal foreign bodies removed in the ENT service of Souza Aguiar Hospital between December 1992 and December 1998 were evaluated according to the parameters related above.ResultsWe found higher incidence between 0 and 4 years of age, and the most frequently found foreign bodies were foam fragments, plastic pieces of little toys, beans and paper fragments. Complications occurred in 9.05% of the cases, epistaxis and vestibulitis being the commonest.ConclusionNasal foreign bodies are especially found between the ages of 0 and 4 years. In our study, foam fragments and small plastic objects were the most frequent foreign bodies found. Complications were found in 9.05% of the cases, headed by epistaxis and nasal vestibulitis.

The case report presented is a 22-year-old female with an undiagnosed nasal foreign body (NFB) in her right nasal cavity for 18years. Previous physical examination and anterior rhinoscopy by other health care specialists failed to detect the NFB. She was treated conservatively by many ENT specialists as sinusitis with antibiotics therapy and anti-allergy drugs for many years with no improvement. Due to persistent sinus symptoms unrelieved by conservative treatment further investigation with a paranasal sinus computed tomography (CT) scan was completed that identified the NFB. The NFB was successfully removed surgically with the aid of nasal endoscopy under general anesthesia. The NFB was diagnosed as a piece of calcified externally cotton vegetation. This case highlighted the importance of complete investigation of persistent symptoms including imaging with a non-contrast spiral CT, in addition to a dilated physical examination, clinical and pathologic lab exam.

Objectives: To assess the characteristics of 195 cases with nasal foreign bodies regarding the sex , age , types , site and complain at presentation. Materials and Methods : One hundred ninety five patients with nasal foreign bodies , their age range of 1-12 years old visiting the private clinic from March 2010 – June 2015 retrospectively analyzed. Results : The nasal foreign bodies mostly presented with males , the most common age group from 1-6 years and the most common foreign bodies were beads and plastic toys. Conclusions : Nasal foreign bodies one of the most common otolaryngological emergencies in pediatric practice , although it is not life threatening , it still need special care to prevent complications.

Foreign bodies of the nose are mostly common in paediatric population. In teenagers and adults, they are predominately seen in patients with mental disturbances. Usually with acute presentation, they also can remain in place for a long time. The main clinical presentation is unilateral purulent rhinorrhea possibly associated, in chronic cases, to nasal deformities, nasomaxillary abnormalities or rhinolithes. The removal can require a surgical procedure under general anaesthesia specifically in front of neglected foreign bodies covered by mucosa or previous multiple failed attempts. We report the case of a 14-years-old girl, with mental retardation, who consulted in our structure for a swelling in the left nasal alar base evolving progressively since 4 months, with intermittent purulent rhinorrhea not improved after medical treatment. No incident of nasal foreign body insertion was reported or witnessed by the patient and its family. The facial CT scan confirmed the diagnosis and the removal required surgical procedure. The diagnosis of neglected nasal foreign body should always be considered in front of unilateral nasal obstruction and discharge specifically in children and mentally disabled patients. Its removal should be rapid in order to avoid the constitution of rhinolithes and nasal deformities.