Nasal foreign body

What it is

An intranasal foreign body is most commonly found in young children, in the cognitively impaired, and in psychiatric patients. Button batteries and paired disc magnets are the two objects to name at once, because they can cause serious damage to nasal structures and need urgent removal.

How it presents

Unilateral nasal obstruction, unilateral epistaxis, and foul-smelling purulent rhinorrhea are the symptoms, with mouth breathing. The clinical features listed are:

• Unilateral foul smelling rhinorrhea
• Nasal obstruction
• Exocriation of vestibular skin and upper lip

The discharge is unilateral, and it may be purulent and foul-smelling or blood stained, in a young child.

The rule to carry is this: if a child presents with unilateral, foul-smelling nasal discharge, a foreign body must be excluded.

How it is diagnosed

Inspection of the nasal cavity with a headlight or an otoscope comes first, and rigid or flexible fiberoptic endoscopy follows when the foreign body is not visible by otoscope.

Nasal foreign bodies are typically located on the floor of the nasal passage under or near the inferior turbinate, or superiorly in the nasal cavity just anterior to or in front of the middle turbinate. Those are the two places to look.

X-ray does not answer the question on its own. An object may show as a radiopaque shadow, but the X-ray may not show the foreign body at all.