Pediatric emergency medicine trisk 3269 3269

typically benign situation into a potentially emergent airway foreign body
aspiration.
Initial Assessment
A child may be witnessed placing a foreign body in the nose. More commonly,
the child will report what they have done to a parent or caregiver. Determining
what type of object was placed is important to determining approaches to
removal. Alternatively, when persistent nasal discharge, particularly unilaterally,
is the primary complaint, gaining information about the chronicity of symptoms
becomes important. On physical examination, the nasal cavities may need to be
suctioned to visualize if an object is present. Sometimes, suctioning results in
removal of the object. During anterior rhinoscopy, the location of the foreign
body and any other injuries should be noted. Plain films are not indicated unless
there is specific concern for a radio-opaque foreign body that is not identified
during direct visualization.
Management
Prior to any removal attempt, a topical nasal vasoconstricting agent such as
oxymetazoline should be used to decongest the mucosa and minimize potential
bleeding. In the cooperative child, instruments can be used to grasp and remove
the object. Alternatively, a 5-French Foley catheter or commercially available
device (e.g., Katz extractor) can be inserted behind the object and the balloon
inflated to extract the object. Young or uncooperative children may require
anxiolysis or procedural sedation, although this is less common than with ear
foreign bodies. Otolaryngology should be consulted for long-standing foreign
bodies, particularly with associated granulation tissue or concern for concurrent
infection. Acute and long-term management strategies will vary by case.
For recently placed foreign bodies, which are removed successfully, no further
treatment is required. For subacute or chronic foreign bodies, antibiotics are often
administered after removal to prevent infections including sinusitis. Children may
be discharged home. Caregivers should be advised that the nose may continue to
have small amounts of bleeding at home. When removal is not successful by
emergency clinicians, otolaryngology should be consulted. Subsequent removal

may occur during the ED visit or in an outpatient setting.

Trauma to the Nose and Sinuses
Goals of Treatment