Foreign Bodies in the Nose

Children by far like to probe into the apertures in their bodies, may be due to a natural curiosity or by way of a strange habit and the nose is usually a favorite one. In the process, they push in different items that are small enough to pass through them. Foreign bodies are far riskier in the nose than in the ear and should be dealt with as an emergency. The child should be seen by an E.N.T. specialist at the earliest.

Clumsy attempts at self-removal may result in the foreign body lodging deeper into the nose or worse still, dropping back into the throat and from there into the trachea or the bronchus which may, God forbid, result in a tragic outcome.

 I have removed a variety of foreign bodies from the nose; nuts and seeds of all hues, buttons and beads, pieces of paper, sponge or plastic, colourful bindies and even button cell batteries. Of special mention among these are the peanut and the tamarind seed which were by large the most popular. These are more dangerous in the nose than in the ear as they swell up by absorbing the moisture in the nasal mucous causing complete blockage of the air passages or worse, they may slip into the trachea to choke the child. The outer red skin of the whole peanut when soaked in the nasal discharge is often camouflaged by the pinkish mucosa of the airway. Sometimes these may remain for long in the nasal cavity and may present with recurrent nasal discharge often blood tinged on one side of the nose with an associated foul smell, which is often diagnostic of a foreign body in the nose.

I would suggest that children be allowed to eat such nuts only under strict supervision, to prevent mishaps and trips to the Emergency Department.

The case that stands out in my mind is that of a pretty 5-year-old brought to me by her doting parents, It was all the more poignant as she was the product of a precious pregnancy and the only child to her obviously ‘over the hill’ parents. The little girl was plagued with a runny nose, recurrent fevers, cough and worse, a putrid smell, if one went close enough to her. This had gone on for a couple of weeks while the parents went haywire seeking help. Seeing the greenish discharge and the foul smell emanating from her right nostril, I immediately posted her for an endoscopy. The culprit was a dirty green button battery cell which on contact with the mucus had reacted to cause extensive damage to the nasal mucosa and to the cartilage of the nasal septum. Unfortunately for the child, the cell had remained long enough to cause significant local destruction of tissues. She ended up with a perforation of the nasal septum but thankfully the cell had not slipped into the trachea or bronchus where it could have been life threatening. The distraught parents had no idea of where the child had got the cell. It was only days later that they discovered that the child had extricated it from a cute dancing doll that they had gifted her on her fifth birthday. The child is doing well now and on follow up. She may later need surgical correction to her nasal septum which had unfortunately perforated due to the corrosives that had leaked from the battery.

It is better that toys with very small parts, even if well hidden inside, be not given to children when they play unsupervised. Children by virtue of their natural curiosity love to explore and discover.

Nasal foreign bodies are uncommon in adult hood. However certain diseases are associated with a loss of sensation in the nose and may lead to a curious condition called Myiasis. Flies, like the fruit fly, lay their eggs in the nose and when the eggs hatch, the larvae emerge and thrive by feeding on the flesh in the nose, all facilitated by the loss of sensation. They usually present with blood tinged nasal discharge and foul smell with irritation or pain due to the inflammation of the surrounding tissues. They are usually treated by actually picking out the larvae and preventing the flies from getting an access to the nose in addition to other general measures by the treating doctor.

Sometimes, very small foreign bodies lodge in the nooks and crannies of the nose forgotten and unattended for years. These may present later on in life as a ‘Rhinolith’ – literally nasal stone, which is nothing but a calcareous deposition of minerals and salts over the years over this foreign body. They present with symptoms like nasal block or foul-smelling discharge due to their sheer size or due to secondary infections and will need to be removed, usually in a surgical procedure.  I had the fortune to remove such a Rhinolith from the nose of a senior fellow otolaryngologist who was quite taken aback and even I suspect a little amused to think that he had carried it along for so many years.