Nasal Foreign Body Research Articles

How did that get there? A population-based analysis of nasal foreign bodies.

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.

A New Positive-Pressure Device for Nasal Foreign Body Removal

Nasal foreign bodies (FBs) are common causes of pediatric emergency consultations. The different methods for removing nasal FBs have varying levels of efficacy. The aim of this study was to evaluate the safety and efficacy of a new device for nasal FB removal in children. A nasal occlusion device that uses modulated positive pressure to remove FBs was evaluated in a series of 18 patients ranging in age from 1 to 8 years diagnosed with a nasal FB during a period of 7 months. The device successfully removed FBs in 17 (94.4%) of the 18 patients. In 12 of the cases (66.7%), the FB was removed during the first attempt. None of the patients had complications or sequelae at the time of removal or at the follow-up visit. The nasal occlusion device used in this study was found to be a promising, safe, effective, and easy to use tool for FB removal in a pediatric emergency room setting.

Characteristics of canine nasal discharge related to intranasal diseases: a retrospective study of 105 cases

To compare characteristics of nasal discharge caused by different intranasal aetiologies in dogs. Medical records of 105 dogs with nasal discharge due to intranasal disease were retrospectively reviewed with special focus on composition, severity, duration and localisation of discharge. On the basis of diagnostic findings, cases were classified into different disease groups and characteristics of discharge were compared between groups. Cases were classified as having non-specific rhinitis (n=42), nasal neoplasia (n=23), foreign bodies (n=21), nasal mycosis (n=7) and miscellaneous disorders (n=13). Dogs with foreign bodies or nasal mycosis were significantly younger. Mucous components of discharge occurred more often in non-specific rhinitis and nasal neoplasia, although haemorrhagic components predominated in nasal neoplasia when discharge lasted ê14 days. Pure or mixed haemorrhagic discharge was significantly more common with nasal neoplasia, foreign bodies and nasal mycosis. Purulent components were associated with longer duration of discharge and predominantly seen in non-specific rhinitis and foreign bodies. Dogs with foreign bodies were presented earlier and sneezing was more frequent. Nasal stridor was significantly more often observed in dogs with nasal neoplasia. Characteristics of nasal discharge and associated clinical signs might aid in planning the diagnostic approach, but a combination of diagnostic techniques is still required to confirm a diagnosis.

Seventeen-year-old asymptomatic foreign body in the nose: Case report

Several symptoms may be present in the case of a nasal foreign body. These symptoms include nasal discharge, epistaxis, infection, halitosis, foul breath or body odor, and chronic sinusitis. However, the presence of a nasal foreign body without these symptoms remains unreported. In this study, we present a case in which the foreign body stayed inside the patient's nose for 17 years after a trauma without symptoms like nasal discharge, epistaxis, infection, halitosis, foul breath or body odor, and chronic sinusitis.

Cosmetic nose pin: An unusual foreign body

We want to emphasize preoperative removal of such ornaments but if somehow it is not possible as it was in our case then such ornaments should be removed with utmost care. The anesthesia team should remain alert during these maneuvers as there is high possibility of misplacement of these objects. Such nasal foreign bodies are typically found around the floor of the nose just below the inferior turbinate [1] as it was in our case also.

Respiratory Diseases of Small Ruminants

Small ruminants are valuable assets for the Mediterranean, African, and Southeast Asian countries with the potential for providing meat, milk, and wool. These animals are highly susceptible to respiratory diseases, which account for almost 50% mortality amongst them. Irrespective of the etiology, the infectious respiratory diseases of sheep and goats contribute to 5.6 percent of the total diseases of small ruminants. The infectious respiratory disorders are classified into two groups: the diseases of upper respiratory tract including sinusitis caused by the larvae of parasites, nasal foreign bodies, gaseous irritation, and enzootic nasal tumors and the diseases of lower respiratory tract comprising mainly pneumonia. Often these are of infectious origin (bacterial, viral, or fungal). However, the role of the environmental pollutants, toxicants, and mechanical induction of respiratory distress may also be the cause of these abnormal conditions. Depending upon the environmental, physiological, and etiological factors, respiratory conditions might be acute, chronic, and/or progressive in nature. To overcome such important disease conditions, information on their identification, prevention, cure, and control can improve the economic status and sustainability of holders of small ruminants. Thus an early, rapid, and specific diagnosis of such diseases holds great importance to reduce the losses. The advanced enzyme-linked immunosorbent assays (ELISAs) for the detection of antigens as well as antibodies directly from the samples are primarily available for all the disease conditions with specificity and sensitivity. Similarly, molecular diagnostic assays along with microsatellites comprehensively assist in diagnosis as well as treatment and epidemiological studies. The two reviews written by Chakraborty et al. and Kumar et al. discuss the advancements made in the diagnosis of common infectious respiratory diseases of sheep and goats, in general, and also the management of Mycoplasma agalactiae, a causal agent of classical contagious agalactia (CA). CA is a serious, economically important but neglected enzootic disease of small ruminants. Both reviews would certainly assist in designing appropriate prevention protocols and devising suitable control strategies to overcome such important respiratory diseases, thus alleviating the economic losses. The cross-reactivity and differential immunogenicity between Mycoplasma agalactiae and Mycoplasma bovis, two often confusing pathogens causing contagious agalactia, have also been elaborated in the research article authored by Kumar et al. The research article by P. Scott details the antibiotic treatment response in sheep with chronic lung diseases where the diagnosis was based upon ultrasonographic examination of the lungs using 5 MHz linear and sector scanners with no consideration to the auscultation findings. The lung pathological examinations were considered a basis for comparison between sonographic findings and pathological changes. Rahal et al. described in detail how a number of pathogenic microorganisms have been implicated in the development of respiratory diseases but the importance of environmental factors in the initiation and progress of the disease can never be overlooked. These environmental factors irritate the respiratory track producing stress in the microenvironment causing a decline in the immune status of the small ruminants and thereby assisting bacterial, viral, and parasitic infections in breaking down the tissue defense barriers. Environmental pollutants cause acute or chronic reactions as they deposit on the alveolar surface, which are characterized by inflammation or fibrosis and the exhibition of transitory or persistent tissue manifestation. The disease development can be portrayed as three sets of two-way communications among pathogen, environment, and host but the interactions are highly variable. Moreover, the environmental scenario is never static; new compounds are introduced daily making a precise evaluation of the disease burden almost impossible. The last article in the issue presents a detailed overview of these interactions and the ultimate effect on the respiratory health of sheep and goat.

A case series of button batteries as nasal foreign bodies among children

Foreign bodies are a common occurrence in children that may be either accidental or self-induced as a matter of habit. Various materials have been reported as foreign bodies like metal, plastic toy parts, food matters, etc. Button batteries have been reported as foreign bodies in the nose and are especially relevant, due to their early chemical disintegration in contact with mucosal surface; hence, need emergency surgical intervention to avoid complications like septal necrosis and perforation. Here, we report four cases of button batteries in the nose at various stages of presentation with their sequelae along with a review of literature.

An Entangled Fish Hook in Nose: A Tricky Case

ENT practitioners encounter different types of nasal foreign bodies in their daily practices. A variety of nasal foreign bodies have been described in literature. Here we present a case of an entangled fish hook in the nose of a 30-year-old fisherman.

An Unusual Foreign Body in the Nasal Cavity

The nasal foreign bodies are commonly seen up to the age of 12. This is a rare case of a 10-year-old boy who had playfully introduced an almost straight sharp rigid iron wire of length 13 cm into his nose. The patient presented with the foreign body protruding outside his nose. Radiological investigations revealed that the foreign body had hooked around the posterior end of the bony septum which was removed under endoscopic guidance.

An unusual entry site for a nasal foreign body: a neglected trauma patient

Foreign body (FB) in the nose is a frequent situation seen generally among children. A variety of objects left in different sites of the nose has been reported in the literature. Insertion of a FB to the nose is generally via the anterior nares. In this report, an unusual entry site for a nasal FB in a neglected trauma patient is presented. FB should be suspected and investigated in children after penetrating facial injury.

Macrophage Polarisation: an Immunohistochemical Approach for Identifying M1 and M2 Macrophages

Macrophage polarization is increasingly recognised as an important pathogenetic factor in inflammatory and neoplastic diseases. Proinflammatory M1 macrophages promote T helper (Th) 1 responses and show tumoricidal activity. M2 macrophages contribute to tissue repair and promote Th2 responses. CD68 and CD163 are used to identify macrophages in tissue sections. However, characterisation of polarised macrophages in situ has remained difficult. Macrophage polarisation is regulated by transcription factors, pSTAT1 and RBP-J for M1, and CMAF for M2. We reasoned that double-labelling immunohistochemistry for the detection of macrophage markers together with transcription factors may be suitable to characterise macrophage polarisation in situ. To test this hypothesis, we have studied conditions associated with Th1- and Th2-predominant immune responses: infectious mononucleosis and Crohn’s disease for Th1 and allergic nasal polyps, oxyuriasis, wound healing and foreign body granulomas for predominant Th2 response. In all situations, CD163+ cells usually outnumbered CD68+ cells. Moreover, CD163+ cells, usually considered as M2 macrophages, co-expressing pSTAT1 and RBP-J were found in all conditions examined. The numbers of putative M1 macrophages were higher in Th1- than in Th2-associated diseases, while more M2 macrophages were seen in Th2- than in Th1 related disorders. In most Th1-related diseases, the balance of M1 over M2 cells was shifted towards M1 cells, while the reverse was observed for Th2-related conditions. Hierarchical cluster analysis revealed two distinct clusters: cluster I included Th1 diseases together with cases with high numbers of CD163+pSTAT1+, CD68+pSTAT1+, CD163+RBP-J+ and CD68+RBP-J+ macrophages; cluster II comprised Th2 conditions together with cases displaying high numbers of CD163+CMAF+ and CD68+CMAF+ macrophages. These results suggest that the detection of pSTAT1, RBP-J, and CMAF in the context of CD68 or CD163 expression is a suitable tool for the characterisation of macrophage polarisation in situ. Furthermore, CD163 cannot be considered a reliable M2 marker when used on its own.

Acute Bacterial Sinusitis in Children

On the basis of strong research evidence, the pathogenesis of sinusitis involves 3 key factors: sinusostia obstruction, ciliary dysfunction, and thickening of sinus secretions. On the basis of studies of the microbiology of otitis media, H influenzae is playing an increasingly important role in the etiology of sinusitis, exceeding that of S pneumoniae in some areas, and b-lactamase production by H influenzae is increasing in respiratory isolates in the United States. On the basis of some research evidence and consensus,the presentation of acute bacterial sinusitis conforms to 1 of 3 predicable patterns; persistent, severe, and worsening symptoms. On the basis of some research evidence and consensus,the diagnosis of sinusitis should be made by applying strict clinical criteria. This approach will select children with upper respiratory infection symptoms who are most likely to benefit from an antibiotic. On the basis of some research evidence and consensus,imaging is not indicated routinely in the diagnosis of sinusitis. Computed tomography or magnetic resonance imaging provides useful information when complications of sinusitis are suspected. On the basis of some research evidence and consensus,amoxicillin-clavulanate should be considered asa first-line agent for the treatment of sinusitis.

A novel method of removing friable paediatric nasal foreign bodies using a “double wax hook”

A novel method of removing friable paediatric nasal foreign bodies using a “double wax hook”

Increase in Pediatric Magnet-Related Foreign Bodies Requiring Emergency Care

We describe magnetic foreign body injuries among children and obtain national estimates of magnetic foreign body injury incidence over time. We searched the National Electronic Injury Surveillance System for cases of magnetic foreign bodies in children younger than 21 years in the United States, from 2002 to 2011. Cases were analyzed by location: alimentary or respiratory tract, nasal cavity, ear canal, or genital area. We identified 893 cases of magnetic foreign bodies, corresponding to 22,581 magnetic foreign body cases during a 10-year period (95% confidence interval [CI] 17,694 to 27,469). Most magnetic foreign bodies were ingested (74%) or intranasal (21%). Mean age was 5.2 years for ingested magnetic foreign bodies and 10.1 years for nasal magnetic foreign bodies (difference 4.9; 95% CI 4.1 to 5.6), suggesting different circumstances of injury. The incidence of pediatric magnet ingestions increased from 2002 to 2003 from 0.57 cases per 100,000 children per year (95% CI 0.22 to 0.92) to a peak in 2010 to 2011 of 3.06 cases per 100,000 children per year (95% CI 2.16 to 3.96). Most ingested magnetic foreign bodies (73%) and multiple magnet ingestions (91%) occurred in 2007 or later. Patients were admitted in 15.7% of multiple magnet ingestions versus 2.3% of single magnet ingestions (difference 13.4%; 95% CI 2.8% to 24.0%). Magnet-related injuries are an increasing public health problem for young children, as well for older children who may use magnets for play or to imitate piercings. Education and improved magnet safety standards may decrease the risk small magnets pose to children.

Nasal Actinomycosis Mimicking a Foreign Body

Nasal actinomycosis is a rare disease. We present a case of nasal actinomycosis causing symptoms similar to those of a nasal foreign body. A 34-year-old woman presented with a long history of halitosis and unilateral offensive, purulent rhinorrhea. Rigid nasendoscopy showed a hard, dark gray mass between the middle and inferior turbinates. Computed tomography findings were typical of a nasal foreign body. Endoscopic removal of the mass was performed, and histopathology established a diagnosis of actinomycosis. We suggest that every clinician confronted with unilateral nasal symptoms and/or signs should have this clinical entity in mind, since it has justifiably been characterized as the head and neck "mimic."

Association between the self-insertion of nasal and aural foreign bodies and attention-deficit/hyperactivity disorder in children

ObjectiveTo investigate whether the prevalence of attention-deficit/hyperactivity disorder (ADHD) is higher in children presenting with nasal and aural foreign bodies than in the control group. MethodsThe present study was conducted between April 2012 and December 2012 and included 60 pediatric patients presenting with self-inserted nasal and aural foreign bodies and 50 healthy controls aged between 3 and 9 years. The Conner Parent Rating Scale (CPRS) and Turgay's DSM-IV based ADHD and disruptive behavior disorders screening scale (T-DSM-IV-Scale) were used to investigate ADHD. ResultsThe difference between the patient group and the control group was significant with respect to the abnormal scores obtained from all the subscales (p<0.05). In children between 5 and 9 years of age, the abnormal scores were significantly higher in the patients than the controls for all the subscales (p<0.05). However, in children between 3 and 4 years of age, there were no significant differences between the patients and the controls for the scores obtained from all the subscales (p>0.05). No statistically significant difference was found between the patients with a previous history of self-inserted foreign bodies and those without any history of foreign body insertion (p>0.05). ConclusionsThe findings of our study demonstrated a possible association between the self-insertion of nasal and aural foreign bodies and ADHD. Clinicians should be aware of the possible presence of ADHD in children, especially in those patients between 5 and 9 years of age who present with self-inserted nasal and aural foreign bodies.

The Necessity of Simple X-ray Examination

Since the discovery of button battery, it has been widely applied in various electric devices. However, the button battery has a potential risk as a foreign body in the nasopharyngeal field. Thus, there is a need for early diagnosis and removal of these batteries. We experienced a case of foreign body in the nasal cavity. A battery was lost around a 2-year-old patient. He visited a local pediatric clinic. X-ray examination of the neck, chest. and abdomen showed no sign of a foreign body. He subsequently exhibited left cheek swelling and came to our clinic. X-ray examination of head revealed a metallic foreign body in the left nasal cavity. The foreign body was approached using an endoscope under general anesthesia. The nasal cavity was filled with necrotic tissue. We removed the foreign body using forceps. After surgery, perforation of nasal cavity was identified. The button battery was a potential risk because it contained toxic substances, could release an electrical current, and exerted direct pressure on the surrounding tissues. Surgical removal of button battery is the treatment of first choice. As for late complications, saddle nose is reported. Our patient would receive nasoplastic surgery around the age of 18 years. In summary, our patient's nose was not initially examined using x-ray study. It is very important to keep in mind the possibility of a nasal foreign body, not only for ear, nose, and throat doctors but also for pediatricians.

A “Mother's Kiss” for Removal of Nasal Foreign Bodies

The “mother's kiss” is a technique first described in 1965 for nasal foreign body removal in children. A trusted adult occludes the unaffected nostril

Angiomyolipoma of the Nasal Cavity Resected with Preoperative Angio-Embolization

Received February 7, 2013 Revised April 22, 2013 Accepted April 22, 2013 Address for correspondence Jung Hyun Chang, MD, PhD Department of Otorhinolaryngology, National Health Insurance Corporation, Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang 410-719, Korea Tel +82-31-900-0346 Fax +82-31-900-0613 E-mail manbang5@naver.com Angiomyolipomas (AML) are generally known as benign tumors. The kidney is the most common location of this tumor, and the liver is reported as the second most common site. Occurrence in other tissues is extremely rare. For instance, some cases of AML originating from the nasal cavity have been previously reported. We describe an AML case arising from the nasal cavity of a 56-year-old man. The patient had been complaining of nasal obstruction and foreign body sensation in the nasopharynx and was initially treated with preoperative angio-embolization. AML was then totally removed by endoscopic surgery without complications. He has been asymptomatic and has had no evidence of recurrence for 2 months after surgery. Korean J Otorhinolaryngol-Head Neck Surg 2013;56:528-31

Ear, nose, and throat foreign bodies in a tertiary health institution in Sokoto, Nigeria

Background: Otorhinolaryngeal foreign bodies are common in ear, nose, and throat (ENT) practice. The objective of this study is to determine the pattern of otorhinolaryngeal foreign bodies in a Tertiary Health Institution in Sokoto, North-Western Nigeria. Materials and Methods: This is a 2 year retrospective study using the records of all cases of ENT foreign bodies at Usmanu Danfodiyo University Teaching Hospital, Sokoto, from January 2009 to December 2010. Data analysis was carried out using the SPSS for windows version 13.0. Results: A total of 90 cases were analysed. Ear foreign bodies 48 (53.3%) were commonest, followed by nasal foreign bodies 16 (17.8%), bronchial foreign bodies 15 (16.7%), and esophageal foreign bodies 11 (12.2%). Age range was 9 months to 64 years. High frequency of the foreign bodies was noted in the younger age group. The foreign bodies varied according to the site with plant seed being more common in the ear and the nose while meat bolus is more common in the esophagus. Bronchial foreign bodies were seen exclusively in children less than 14 years old with beads and valve of plastic toys being the most common. Conclusion: Otorhinolaryngeal foreign bodies remain frequent occurrence particularly in the younger age group 9 years old or less and high index of suspicion suggested and early intervention to prevent the morbidity and mortality from complications.