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elevated. Otolaryngology and neurosurgery should be consulted. Prophylactic
antibiotics are controversial.

TRAUMA TO THE NOSE AND SINUSES
Nasal Foreign Body
Goals of Treatment
The goal of treatment is to identify a nasal foreign body, to allow prompt
removal. Safe removal of the foreign body reduces the risk of acute aspiration,
subacute local infection, sinusitis, and cartilaginous injury.
CLINICAL PEARLS AND PITFALLS
Unilateral malodorous nasal discharge should raise suspicion for a
nasal foreign body.
Care must be taken to avoid pushing or irrigating the object during
examination or removal attempts, as migration to the nasopharynx puts
the child at risk for aspiration.
Pretreatment with vasoconstrictor as well as use of a nasal speculum
can improve visualization and facilitate removal.
A known or suspected disc battery should be removed immediately to
avoid caustic injury.

Current Evidence
Foreign bodies can obstruct the nares. If the object has been present for an
extended duration, granulation tissue can form around the object. Either the tissue
or the object itself can block the ostia and increase the risk of infection.

Clinical Considerations
Clinical Recognition
Witnessed insertion or foul unilateral discharge is key to diagnosing a nasal
foreign body.
Triage
Children generally present to triage well appearing with a history consistent with

foreign body. Rarely, associated injury may result in epistaxis that should be
addressed urgently. Nasal foreign bodies can migrate posteriorly, changing a