A foreign body in the nasal meatus of a child is a common problem.
Typical foreign bodies in the nose include pearls, marbles, plastic toy parts, coins, peas, nuts and pieces of rubber, foamed plastic or paper.
A button cell battery in the nose will cause severe corrosive damage within a few hours.
Water-absorbing foreign bodies swell in the nose. Adjacent mucous membranes become irritated and swollen. The swollen mucosa and increased secretions retain the foreign body in place.
Foreign bodies are usually located under the inferior nasal concha or between the inferior concha and the septum.
Do not push the foreign body backwards.
Symptoms and diagnosis
The diagnosis is often quite evident: the parents notice that there is a foreign body in the nasal passage of the child, or the child (or carer) may tell about the possibility of a foreign body. If the diagnosis is delayed, unilateral nasal obstruction is a common symptom.
There may also be unilateral purulent foul-smelling discharge from the nose.
The diagnosis is usually confirmed by looking into the nose. The foreign body is rarely in the posterior parts of the nose and it is often visible when looking into the nose with a head lamp and a nasal speculum.
The mother, the father, or some other close adult covers the child's mouth tightly with her/his lips, the unobstructed nostril is pressed closed, a sharp and quick blow of air is directed into the child's mouth, and the current of air will remove the foreign body.
If the foreign body cannot be removed by blowing, a vasoconstrictor is used to constrict the mucous membranes and the nasal passage is anaesthetised (cotton wool soaked with lidocaine-adrenalin solution) for mechanical removal.
Under local anaesthesia, after the removal of secretions by suction, the foreign body is best removed by suction, with probes, with a small suction cup or with small forceps under visual control using a nasal speculum.
When removing hard or fragile foreign bodies the probe should be passed behind it, and then pulled back with the foreign body.
During mechanical removal, the foreign body must not be pushed into the nasopharynx, from where it may easily fall into the trachea, particularly in a screaming child. Since the nasal mucous membranes are easily damaged, local anaesthesia and vasoconstriction are worthwhile to apply, and the removal must be gentle. The patient's head should be supported and a child held in a firm grip on the lap.
A button cell battery is corrosive and may cause septal perforation within a few hours already. Therefore, all cases of suspected button cell battery as foreign body must be examined immediately.
If the removal is not successful with the methods described above, the child should be referred to an otorhinolaryngologist. The removal may sometimes require general anaesthesia.
References
Guidera AK, Stegehuis HR. Button batteries: the worst case scenario in nasal foreign bodies. N Z Med J 2010;123(1313):68-73. [PubMed]