Foreign Body in the Nose Removal

Blowing the nose will potentially dislodge the object and is more likely to succeed if the uninvolved nostril is closed during such attempts.

The nose is a surprisingly deep space that extends directly back into the face. A relatively small portion of the nasal cavity is visible by looking into the tip of the nose. In the back of the nose, space turns downward and connects to the back of the mouth.

Only the imagination limits the objects and circumstances that result in things getting stuck inside of the nose.

• Common objects found in noses include food material, tissue paper, beads, toys, and rocks.
• Most cases of foreign bodies in the nose and nasal cavity are not serious and occur in toddlers and children from 1-8 years of age. Children develop the ability to pick up objects at about the age of 9 months, so foreign objects in the nose are much less common in children 9 months of age or less.
• An object that is simply stuck in the nose and not causing other symptoms can usually wait until morning or the following day for removal. The object does, however, have to be completely removed quickly and without discomfort and danger.

In addition, an object stuck in the nose has the potential to dislodge and travel into the mouth where there is the danger of swallowing it, or even worse, inhaling it into the lungs, which may block airflow.

The subject of this article is foreign objects in the nose and it is not intended to cover toxic chemical inhalant toxins that injure the nasal cavity, trauma to the nose, or foreign bodies traveling through the nasal cavity into the lungs.

• The vast majority of foreign bodies are placed in the nose voluntarily for an endless variety of reasons. When questioning children about this possibility, it is important to approach them in a nonjudgmental manner. Otherwise, the adult runs an increased risk that the child will deny having put something in their nose to avoid punishment. This could easily result in a delay of its discovery and increase the risk of complications.
• Trauma is another common cause for items to get shoved inside the nose. When a person falls or gets struck in the face, it is important to consider the possibility that an object may be stuck in the nose and is completely out of view.

Fortunately, most people (adults) can and will tell their doctor about an object's presence in their nose.

• Typically, foreign items in the nose result in complaints of pain or difficulty breathing through that side of the nose.
• Nasal bleeding is also a common symptom of a foreign body in the nose because the tissues of the nose can be easily scratched. Much of this blood can drip down the back of the throat and be swallowed. Because blood is quite nauseating, the person may vomit, which can appear black or bloody, depending on how long the blood remains in the stomach. It is important to distinguish vomiting swallowed blood from vomiting because there is bleeding in the stomach.
• The nasal space connects to the back of the mouth, so it is also possible for an object to be pushed back into the throat. Individuals may swallow the object or choke on it. Complaints of choking, wheezing, difficulty breathing, or inability to talk should prompt an evaluation of the entire nose and throat in addition to the lungs so that foreign bodies will not be overlooked. Gathering information in regard to what kind of foreign object it may have been will assist the health care practitioner to determine if an X-ray will show the object (the object is radiopaque such as metal) or if it will not show up on an X-ray.
• Some individuals, especially children, who are motivated to place something in their nose might also think it is fun to put something in the other side of their nose as well as in one or both ears. A doctor will check all the likely places if there is a suspicion of additional foreign bodies. Moreover, children have been known to place objects in their younger siblings nose, ears, and other places.
• Infection is another common symptom of a foreign object in the nose. Lost or forgotten tissue paper is a common source of such a problem. This scenario is not uncommon in adults and children. People will typically complain of continuing nasal discharge from one side of the nose. Many of these people have been treated with one or more antibiotics. Unfortunately, antibiotics alone will not cure this condition until the object is removed. In addition, the sinuses are all connected to the nasal passages. Because a foreign body in the nose will frequently become infected and block the drainage sites of the sinuses, sinusitis (especially repeated episodes or chronic sinusitis) should also raise the question of a foreign object inside the nose.
• Although a person can usually sense the presence of something out of the ordinary in their nose, it may be confused with nasal congestion, so small objects or torn tissue paper can easily go undetected.
• A foul odor can be a sign of a foreign body that has been in the nose for a period of time. The object can manifest itself by producing bad breath or a foul odor from the nose, possibly linked to a nasal discharge associated with the foreign object.
• The skin under the nose may become raw from the continuous discharge or from frequent wiping. Impetigo is an infection of the skin that is commonly associated with this problem. Impetigo typically appears as a raw rash with faint yellow, crusty material over it. Impetigo just in this area must prompt a thorough evaluation of the nose to ensure that the nose is clear.

When to call the doctor

• Most objects that become lodged in the nose should prompt a call to a doctor. Removal should usually not be attempted at home to avoid further injury.
• If there is any concern that a portion of the object remains in the nose or nasal bleeding continues, a thorough exam should be performed by a qualified health care professional.
• Persistent pain, bleeding, or discharge from the nostril should raise concern that the nasal passages have not been completely cleared. Many objects remain in the nose and cause few symptoms.
• A rash below one nostril or unexplained, continuing sinus pressure should also prompt a thorough evaluation.
• Your primary care health care professional may want to see the patient in their office or refer them to a local emergency department or other specialist. Do not expect any health care professional to be able to assess the situation adequately over the phone. If there is any concern for the presence of a foreign body in the nose, the person should be physically examined by a qualified medical professional.

When to go to the hospital

In the majority of cases a foreign object stuck in the nose will not be life-threatening. The affected person will have time to call a primary care doctor. The urgency of the situation primarily depends on the location of the object, the substance involved, and the symptoms.

• If the foreign body has been inhaled into the person's throat and the person is choking, call 911.
• If the object falls back into the throat and is swallowed, see a doctor for emergency care. A few of these objects can become lodged in the esophagus. If this occurs, the object will need to be either pushed down into the stomach or pulled out by a gastroenterologist.
• An object that contains chemicals, such as button batteries, or the presence of food material also represents a more urgent situation.
• Because the nasal passages are moist, objects such as beans will swell if they remain in a moist environment. This situation may result in increasing discomfort and a more difficult removal of the object.
• Batteries can decompose enough in the body to allow the chemicals to leak out and cause burns.

Most objects can be seen with good lighting and a few instruments. If there is concern about an object deep inside the nasal passages or complications of a serious sinus infection, an exam with a fiberoptic camera or CT scan may be considered.

• Occasionally, an object is discovered accidentally when X-rays are taken for unrelated reasons. It is important to realize that many materials such as food, wood, and plastic will not be visible on a routine X-ray.
• Ask the doctor to examine the entire head and neck region. It is distinctly possible that the person, especially a child, has multiple foreign bodies in both nostrils and in one or both ears.

There are techniques that can be used at home to remove a foreign object from the nose. However, it's advisable to seek medical help if the object is lodged far up in the nose or if it may be pushed farther up the nasal cavity if removal is attempted. Children present a problem because they may be somewhat uncooperative. If medical care is sought to remove the object, give nothing to drink or eat to the person as sedation may be necessary.

It is not advisable for anyone to stick anything in the nose while attempting to remove an object in the nose. A person may complicate matters by pushing the object farther back into the throat and possibly cause the affected person to choke or injure the surrounding tissue. These techniques can be tried safely at home to remove the object.

• Blowing the nose will potentially dislodge the object and is more likely to succeed if the uninvolved nostril is closed during such attempts. Hold the unaffected nostril closed by pressing a finger against the side of the nose.
• A sneeze will actually produce much more force and is an alternative way to push the object forward and out of the nose. Again, it is more effective if the uninvolved nostril is closed.

Many people with foreign bodies in the nose are too young to cooperate with these techniques. A parent or caregiver can attempt to remove the object by sealing their mouth over the child's mouth and closing the unaffected nostril with their fingers. Blowing a quick puff of air into the child's mouth has frequently resulted in the object coming out the nostril onto the caregiver's cheek. This should usually only be attempted under the supervision of a medical professional.

• The child will reflexively protect their lungs, but one should not deliver a large, forceful breath. The potential for spread of infection between the child and caregiver should be considered because there may be contact with the child's nasal secretions, blood, or both during this maneuver. It is recommended that this technique be performed under the supervision of a medical professional.

Nasal bleeding is a commonly associated symptom of a foreign object in the nose. Some episodes of bleeding will stop on their own. Gently placing a towel over the end of the nose is a safe way to contain the associated mess as long as the person can breathe easily. If the bleeding does not stop within 5 minutes, seek medical advice.

• Although the most common recommendation for nasal bleeding (nosebleed) is to pinch the soft part of the nose for 10-15 minutes, this technique may not be appropriate depending on the circumstances and object involved.
• The common home remedy of placing an ice pack behind the affected person's neck is not likely to be effective. Placing a cool compress on the nose itself may occasionally decrease bleeding and has the added benefit of reducing swelling, which may aid in the eventual removal of the object.
• Placing ice or other extremely cold material directly on the tip of the nose is not recommended.

If there is any question about objects in the nose and medical attention is sought, the person should not be given anything to eat or drink until approved by a doctor. The reason for this inconvenience is that some objects are difficult to remove. Sedation is occasionally needed and is done in a medical facility. Sedation works best and has a lower risk for complications if the person has an empty stomach.

Treatment will largely depend on the location and identity of the object or objects involved. There are a variety of treatment options available. The most common ones are mentioned below and throughout this article.

Commonly used techniques include applying gentle suction to the object, long tweezers, or instruments that have a loop or hook at the tip.

• If the object is metallic, a long magnetized instrument may be used to assist in gently pulling the object from the nose.
• Another technique involves gently passing a soft rubber catheter past the object. These catheters have an inflatable balloon at the tip, which can then be inflated and pulled back, along with the foreign body.
• Any experienced health care professional can tell you that children typically struggle when these techniques are used. Struggling will decrease the likelihood of success and increase the likelihood of complications. Sedation may be considered for a child as an option to allow calm and comfortable removal of the object.

A repeat exam after removal of an object from the nose is usually recommended.

• If the person has no symptoms, this exam can be done in a doctor's office within one week.
• If there is any continuing drainage, bleeding, or discomfort, a thorough exam by a qualified medical professional is imperative.

Curiosity and exploration of one's body is a natural stage of development. Teaching a child that it is not good to put anything inside the nose may prevent some of these mishaps. If you suspect a child has inserted something into his or her nose, it is important to approach these situations in a nonjudgmental manner so that the objects can be discovered and safely removed before complications develop.

Most people have no long-term consequences from having an object in their nose. The prognosis may be affected by any of the complications, however. The most serious complication - choking - is rare but can be life-threatening. For this reason, trying to remove the object at home is not recommended if such attempts may push the object farther into the nose.