bubble_chart Overview

A foreign body in the nose refers to an external substance lodged in the nasal cavity. Nasal foreign bodies can be categorized into the following three types: ① Non-living objects, such as candy wrappers, plastic toys, buttons, necklace beads, glass beads, stones, soil, etc. ② Plant-based objects, such as beans, peanuts, fruit pits, etc. ③ Animal-based objects, such as insects, roundworms, maggots, leeches, etc.

bubble_chart Etiology

Foreign bodies can enter the nasal cavity through the anterior nares, posterior nares, or by penetrating the nasal walls due to trauma.

1. Out of curiosity, children may accidentally insert toy parts or food into their nostrils, which then enter the nasal cavity. Afraid to tell their parents, they may forget about it over time until infection and bleeding occur, drawing attention to the issue.

2. During vomiting or sneezing, food or roundworms may enter the nasal cavity through the posterior nares. Occasionally, live fish or shrimp may jump into the nasopharynx and reach the nasal cavity via the posterior opening.

3. Trauma—Foreign bodies may enter the nasal cavity during combat or industrial injuries, often accompanied by foreign bodies in the sinuses or orbits.

4. During nasal surgery, medical staff may inadvertently leave gauze or oiled gauze in the nasal cavity and forget to remove it, resulting in iatrogenic foreign bodies.

5. Insects may lay eggs in the nostrils of debilitated or unconscious patients, leading to maggot infestations in the nose. Residents in tropical areas who drink or swim in unclean water may develop nasal leeches or other foreign bodies.

bubble_chart Clinical Manifestations

The symptoms vary depending on the size, shape, type, and nature of the foreign object. The main symptoms include deep nasal congestion, purulent nasal discharge with a foul odor and blood. Sometimes, chronic nosebleeds can lead to anemia symptoms such as pale complexion, general weakness, easy fatigue, and profuse sweating.

bubble_chart Diagnosis

Take a detailed medical history. Suction secretions from the nasal vestibule and nasal cavity, use vasoconstrictors to reduce swelling of the nasal mucosa, and carefully examine with an anterior rhinoscope or endoscope. If necessary, use a blunt probe to assess the size, nature, and location of the foreign body. X-ray examination is only diagnostic for metallic or mineral foreign bodies.

bubble_chart Treatment Measures

The treatment methods vary depending on the nature of the foreign body.

1. For round and smooth foreign bodies in the anterior part of the nasal cavity, nasal forceps should not be used to avoid pushing the object deeper into the nasal cavity or even causing it to fall into the larynx or trachea, which may lead to the risk of suffocation. Instead, a curved hook or paperclip should be inserted through the anterior nostril, passed over the foreign body to reach its posterior side, and then pulled forward to extract it. For pediatric patients, the entire body should be immobilized to prevent struggling, and general anesthesia may be used if necessary. To prevent the foreign body from being inhaled into the larynx or trachea, the patient should lie flat with the head in a low position.

2. For larger foreign bodies that cannot be hooked out, a heavy-duty nasal forceps can be used to crush them, followed by removal in fragments.

3. For excessively large metallic or mineral foreign bodies, a nasal sinusotomy or lateral rhinotomy can be performed to remove them through the piriform aperture. For foreign bodies located in the maxillary sinus or frontal sinus, a maxillary sinusotomy or frontal ethmoidectomy may be required for extraction.

4. For living animal foreign bodies in the nose, first soak a cotton ball with acetaldehyde or chloroform and insert it into the nasal cavity to immobilize the organism, then remove it with nasal forceps. Recently, it has been found that 2% tetracaine or herring bile powder also has an anesthetic effect on leech suckers.

bubble_chart Complications

Long-term foreign body in the nose can lead to complications such as nasal septum perforation, inferior turbinate necrosis, sinusitis, and nasal stones. In children, prolonged foreign body in the nose may not only cause the aforementioned local complications but also result in anemia and malnutrition due to chronic blood loss.