Foreign body nose

foreign bodies in ENT , foreign body in nasal passages, management of foreign body nose

1. Foreign body nose

2. 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

3. 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

4. Frequently encountered foreign bodies: Pebbles Slate pencils Beads marbles peas Beans nuts button batteries paper wads

5. Types of foreign body ANIMATE: Maggot Worms INANIMATE: Vegetable FB : paes ,beans Mineral FB : metal , plastic toys Post surgical : swabs , packs Sequestra : syphilis , neoplasms

6. 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.

7. Consequences: I nert 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

8. Symptoms: Unilateral fetid discharge: mucopurulent or blood stained u/l nasal obstruction Pain Nasal bleed Excoriation of nasal vestibular skin

9. 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

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

11. 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

12. investigations Nasal endoscopy X-ray may reveal radiopaque FB NCCT nose and PNS

13. DIFFERENTIAL DIAGNOSIS Neoplasm Unilateral sinusitis Unilateral choanal atresia

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. REMoval of rhinolith : Done under general anaesthesia It is removed in peacemeal If very large –it is removed by lateral rhinotomy