FOREIGN BODY NOSE

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WHAT IS FOREIGN BODY?

• An object is considered a "foreign body" if the object is in a location in the body where it does not belong

• Commonly encountered in emergency department• In children (2-4years)• Seen in adults who are mentally retarder or psychiatric

illness• Foreign body nose harbors potential for mortality if the

object is dislodged into airway

FREQUENTLY ENCOUNTERED FOREIGN BODIES:• Pebbles• Slate pencils• Beads• marbles• peas• Beans• nuts• button batteries• paper wads

TYPES OF FOREIGN BODY

• ANIMATE:

1. Maggot

2. Worms

INANIMATE:

1. Vegetable FB :paes ,beans

2. Mineral FB : metal , plastic toys

3. Post surgical : swabs , packs

4. Sequestra : syphilis , neoplasms

BUTTON BATTERIES:• result in severe destruction of the nasal

septum.

• These are composed of various types of heavy metals: mercury, zinc, silver, nickel, cadmium, and lithium. Liberation of these substances causes various types of lesions depending on the localisation,

• it causes intense local tissue reaction and liquefaction necrosis.

• As a result they can cause septal perforations, synechiae, constriction, and stenosis of the nasal cavity.

CONSEQUENCES:

Inert Foreign body

Infection and inflammation of mucous membrane

Granulation tissue formation

and ulceration of mucosa

Necrosis of bone or cartilage

Vegetable foreign body

Absorb water and swell

evoke brisk inflammatory response

SYMPTOMS:

• Unilateral fetid discharge: mucopurulent or blood stained

• u/l nasal obstruction• Pain• Nasal bleed• Excoriation of nasal

vestibular skin

LOCAL EXAMINATION:• Main diagnostic tool• Object mostly found

beneath inferior turbinate or anterior to middle turbinate

• Erythema ,edema• Bleeding ,fetid nasal

discharge• Visualize T.M for acute otitis

media • Nuchal rigidity• Assess for sinusitis

RHINOLITH

• Usually forms around the nucleus of a small exogenous FB, blood clot ,inspissated secretion by slow deposition of calcium and magnesium salts

NASAL MYIASIS (MAGGOTS IN NOSE)

• Larval forms of flies (chrysomyia)

• Attracted by foul smelling discharge (atropic rhinitis , syphilis , leprosy , infected wound)

• Patient presents with intense irritation , sneezing , lacrimation , headache ,epistaxis , foul smell

• Maggots can cause extensive damage to nose , sinuses ,soft tissue of face ,palate and eyeball

• Death can occur from meningitis

INVESTIGATIONS

• Nasal endoscopy• X-ray may reveal

radiopaque FB• NCCT nose and PNS

DIFFERENTIAL DIAGNOSIS

• Neoplasm• Unilateral sinusitis• Unilateral choanal atresia

POSITIVE PRESSURE TECHNIQUE:• Tell the kid that parent is going

to give them a kiss • Instruct the parent to form a

good seal on mouth and then blow into mouth while occluding unaffected nostril

• It has a very low risk of baro-trauma (<60mm hg ) , similar to a sneeze

MANAGEMENT:

ANIMATE FOREIGN BODY (Maggots)• Isolation and broad spectrum antibiotics and analgesics• Good nourishment• Tablet vitamins and iron• Inj . Tetanus• Manual removal of maggots after placing cotton pledgets

soaked in 25% chloroform and terpentine oil(4:1)• Alkaline douchings• Primary causative factor is taken care of

INANIMATE FB REMOVAL:

• Child is restrained in upright position

• Add few drops of nasal decongestant

• Proper suctioning to visualise FB

• Curved hook is passed beyond FB and gradually drawn forward and removed completely

USING FOGARTY CATHETER:• Additional method• Ensure that balloon is

intact• Catheter is placed beyond

the foreign body• Balloon is then inflated • Catheter is withdrawn

through the anterior nares pulling the foreign body

INDICATIONS FOR GENERAL ANAESTHESIA

• Uncooperative and very apprehensive patients• If troublesome bleeding is anticipated • If the FB is posteriorly placed with a risk of pushing it

back in to nasopharynx• If a foreign body is strongly suspected but cannot be seen

in anterior rhinoscopy and radiolucent

REMOVAL OF FB UNDER GENERAL ANAESTHESIA:• Patient is anaesthetised with cuffed ET tube • Pharyngeal pack placed • If FB is placed posteriorly , patient positioned in rose

position and mouth gag applied.• Palate is generally retracted with a catheter which is

placed through unaffected nasal cavity• FB is pushed from anterior nares in to the nasopharynx

and pick up with foreps

REMOVAL OF RHINOLITH:

• Done under general anaesthesia• It is removed in peacemeal• If very large –it is removed by lateral rhinotomy