"Don't Stick That Up There!"
ENT - Foreign Bodies
Nasal Foreign Bodies
Predominantly effects the paediatric population under the age of 5. Most commonly present with a history of putting something up their nose.
Be suspicious if:
- Localised pain
- Unilateral nasal discharge
- Voice change (nasal character)
- Foul breath odour
Most commonly beads, beans, pebbles, peanuts/seeds, toy parts, rolled up paper or erasers from the end of pencils.
Button batteries and magnets are the most concerning foreign bodies. They can cause localised necorsis and destruction, leading to septal perforation.
They otherwise just result in inflammation, bleeding and purulent discharge.
Most commonly located:
- Anterior to the middle turbinate
- Below the inferior turbinate
- Right side > Left side
- Unilateral choanal atresia
Positive Pressure for nasal FBs
Get the person to try blwing their nose or in kids use the "kissing technique". The parents places their mouth over the child's and occludes the unaffected nostril, they then exhale into the child's mouth to create positive pressure.
Ear Foreign Bodies
Again, most commonly in the paediatric population, however also a presentation for adults - particularly those with hearing aides with tiny batteries.
- Asymptomatic - found incidentally
- History of putting something in their ear
- Ear pain/otorrhoea
- Hearing loss
- Feeling like something is moving in their ear
- Vertigo, nystagmus, ataxia, tinnitus
When to refer to ENT
- Patient will require a GA
- Unsuccessful removal attempts (if you can't get it out in 5-10mins then you are probably not going to)
- Ungraspable FB in ear canal or suspicions that it is touching the tympanic membrane
- Sharp objects in the ear canal
- Significant trauma caused by FB insertion or removal
Always try to visualise the nasal cavity or ear canal post removal. Multiple foreign bodies are not uncommon, so check other orifices in the face for other FBs.
Epistaxis can occur post removal. Monitor if suspicion of aspiration. Antibiotic drops if lacerations or otitis externa.
Referral back to GP for review +/- audiology referral.