How Is Foreign Body Removed From Nose?

: Admin : 2022-01-04

What are the foreign bodies that obstruct the nose?

Respiration is the fundamental physiological process that is necessary for the continuation of life on earth. The environment surrounding the man is rich in oxygen which is essential for normal functions of all systems of the body. Nature has its own unique way of releasing oxygen through photosynthesis in exchange for carbon dioxide. The pure oxygen in the atmosphere is inhaled by human beings and animals that get transported within each of their cells to carry out different physiological activities. The air containing a mixture of gases with oxygen enters the nose, reaches the lungs through the trachea and bronchi during the process of breathing. This mixture of gases that forms its passage through the nose or nostrils enters the lungs where oxygen is transported to the blood stream that reaches all parts of the body.  The waste gas or carbon dioxide is exhaled out and removed from the bloodstream. The upper respiratory tract that is formed of the nose, nasal cavity and larynx have a vital role to play in normal breathing that aid in the process of respiration. The medical fraternity has emphasized the fact on importance of health and hygiene of upper respiratory airway passages. The nose and nasal cavity are in direct contact with atmospheric changes, prone to several infections, diseases, injuries and obstruction from the foreign bodies that may enter through nostrils.

Airborne particles entering the nostrils during breathing carry microorganisms with impure, polluted air. Minute, microscopic particles of air do not cause any obstruction to the nasal cavity. Accidental boring or penetration of the nose by foreign objects like food, seeds, dried beans, small toys such as marbles, crayon pieces, erasers, cotton, beads, buttons and disc magnets often get blocked in the nose. Children under the age of five years are victims of such accidents where any foreign object is found struck within the nasal passage which is an unnatural phenomenon. About 0.1% of paediatric medical emergencies come as accidental foreign body insertion in the nose.

Children up to 6 years of age are very curious about every object they see near their play area. They are unable to depict or interpret whether the object is harmful or can be orally consumed as food. Many children have a habit of putting small things in their mouths that are usually found lying on the ground. While exploring the world around them they put foreign objects lying on the ground into their mouth and nose. Parents who are careless or show medical negligence when a child accidentally puts some foreign object into the nose, find their child develop different symptoms, the common ones being difficulty in breathing and choking.

What are the symptoms caused by the foreign body that enters the nose?

A foreign body that enters accidentally into a child's nose can be organic or inorganic in nature. Inorganic materials are plastic, metal, beads, jewels, small earrings and small parts of toys. An organic foreign body is in the form of food, rubber, wood, sponges, peas, beans, and nuts causes irritation of the nasal mucosa when a child subconsciously puts them into his nose.

A child may not be able to narrate symptoms to the doctor when an object gets stuck within the nasal cavity. Children only express through crying, but doctors concluded the symptomatology through physical examination and objective symptoms. Pain is the first symptom that a child might experience when some foreign object enters the nose. Continuous nasal discharge with bleeding can be observed from the child's nostrils. Obstruction caused due to nasal block from foreign body cause sinusitis with foul odour from nose or mouth. Complains of choking, wheezing, gasping for breath, difficulty while breathing and talking are a few more symptoms observed in a child who has a foreign body within the nasal cavity. Infections from foreign body insertion is an associated symptom. It is unlikely for a child above 7 years to put any foreign object into the mouth or nose. Accidents among grown-up children are rare.

HOW ARE FOREIGN BODIES FOUND IN THE NOSE?

A child with any symptoms such as bleeding, nasal discharge, choking and difficulty while breathing should be rushed to a medical professional. It needs urgent medical attention and parents or relatives should not attempt to remove a foreign object from the nose at home. It should be done only by a skilled medical professional in his clinic or hospital.

A doctor first examines the patient thoroughly to locate the foreign body. He examines the nasal passages for complications due to foreign body and sinus infections. X rays are done to locate the foreign body in the nose. CT scan and MRI are useful diagnostic procedures to locate the foreign bodies in the nasal passage.

HOW IS THE FOREIGN BODY REMOVED FROM THE NOSE?

Any foreign object within the body is not recognized or accepted by the body. The defence mechanism tries to expel it or force it out from natural orifices when the body responds in the form of irritation, choking, bleeding or difficulty while breathing. An adult who may accidentally face a situation where a foreign body gets stuck in the nose may try to pull using tweezers or sneeze heavily. Usually, such situations are rare in adults.

A child is often prone to or comes in contact with small objects while playing and accidentally may put them into the nose which may cause a critical situation or an emergency medical condition when he or she experiences difficulty while breathing and bleeding. A doctor should be consulted immediately and all relevant medical investigations as advised by him should be done to locate the foreign body in the nasal passage. A doctor may give a local anaesthetic spray or drops or sedation to make the child comfortable so he may not sense any pain during the procedure of removal of foreign body from the nose. A doctor may use any of the following methods to remove the foreign object.

Suction machines with tubes attached are used to remove foreign objects.

Instruments are inserted into the nose to remove foreign bodies.

A doctor may blow the object out of the child’s mouth. The pressure of air can go through the mouth and block nasal passages that may blow the object out of the nose. Removal of foreign bodies from the nose is very challenging and distressing for the treating physician who adopts different methods to the dugout, extricate and withdraw a foreign object. Parents become frustrated, panic-stricken and anxious seeing their child suffering from symptoms due to the presence of the foreign body in the patient's nose.

These are a few more additional steps and methods, based on experience, knowledge, their skill that are adopted by medical professionals to get rid of foreign bodies from the noses of children who might have accidentally placed harmful objects in the nasal passage.

POSITIVE PRESSURE (CHILD) METHOD 1 – A child is forcibly asked to exhale through the nostril that contains a foreign body while the other nostril is occluded and the mouth is closed. It is impossible for a child to understand this method of removing a foreign body stuck in his nose particularly beads, jewels and similar solid objects. A doctor can apply some pressure and force the object out of the nasal cavity.

MODIFIED POSITIVE PRESSURE (PARENT) METHOD – A parent is asked to use a drinking straw or similar soft tube-like material, which is placed between the parent's mouth and the child's mouth. A child is held tightly by the attendants, while the parent delivers a quick puff through the straw to remove the foreign object.

POSITIVE PRESSURE WITH AMBU BAG – An oral infusion of air into an ordinary Ambu bag when parent and child have difficulty removing the foreign body through the mouth to mouth positive pressure.

POSITIVE PRESSURE DEVICE 4 – In this method, a nasal occlusion device is used which consists of a medium or large disposable headset attached to an 8F feeding tube. The headset includes a hose that is connected to an oxygen outlet with an oxygen flow rate of 15 L/min. The child is comfortably made to sit on the parent's lap, the occlusion device is connected to an oxygen hose. The oxygen outlet is opened and oxygen is released with a pressure of 15L/min. The device is placed in the unaffected nostril, the pressure is then suddenly released, the nose bend blocks the passage from pressure.  The device is immediately removed after the positive pressure from air suction removes the foreign object.

BEASLEY PLASTER POSITIVE PRESSURE DEVICE- 4 – This technique uses an oxygen tube adapter that forces an unmodulated pressure in the nasopharynx to push the object out of the nose. This procedure is risky as it may cause complications.

SALINE WASHOUT TECHNIQUE – In this technique a bulb syringe is filled with 7ml sterile normal saline which is placed in the healthy nostril. The bulb syringe is advanced deep inside the nasal cavity and is forcibly squeezed. The object is tried to force out by the flow of saline into the nasal passage that contains a foreign body.

CYANOACRYLATE – or SUPER GLUE – This glue is applied to one end of the plastic swab stick. It should be held for about 60 seconds near the nasal foreign body which get stuck to the glue and can be removed.

CATHETERS  -- Foleys catheter, Fogarty vascular catheters, Fogarty biliary balloons are used to remove foreign nasal objects. The catheter is inserted above and distal to the foreign object that moves the object to a tighter position. The balloon is inflated with a certain predetermined amount of saline. This pressure is maintained by the treating physician who applies gentle traction to remove the foreign object. This technique is very successfully used to remove foreign bodies from the nose.

THE KATZ EXTRACTOR – The success of using catheters in the removal of foreign bodies from the nose, has led to the development of small disposal Katz extractors.  These advanced miniature size catheters can be passed beyond the foreign object in the nasal cavity and objects can be easily pulled out.

A MAGNETIC DEVICE  using a strong magnet is used to pull buttons, small earrings, pieces of ornaments or jewels that might have gone accidentally within the nasal cavity.

ALLIGATOR FORCEPS can be inserted into the nasal cavity to pluck and grasp the object out of the nasal cavity.

TILLEY NASAL PACKING FORCEPS is a type of forceps that propels objects that cannot be extracted using an alligator forceps technique.

JOBSON HOME PROBE is a method in which the nasal tip of the child is elevated and the medical professional inserts a probe into the nasal cavity. The probe is passed beyond the foreign body, tilted at an angle to push the object out of the nasal cavity. The probe is later removed from the nose.

A RIGHT ANGLED PROBE is used to extract foreign objects inserted into the nasal cavity. This method involves rotation of the probe to a right angle beyond the object to gently withdraw the nasal foreign body out of the cavity.

 FRAZIER SUCTION CATHETER uses a method of suction to pull out the nasal foreign body with the help of a catheter.

CUT DOWN FLEXIBLE SUCTION CATHETER  -- In this method, one end of the suction catheter is placed on the object. Gentle suction is applied to pull the foreign object out of the nasal cavity with the help of the catheter.

SNARE TECHNIQUE – In this technique a 24 gauge wire snare loop is created which is inserted into the nostril carrying the foreign body. Once the loop identifies the foreign body, it is rotated to 90 degrees and the foreign object is later pulled out.

ENDOSCOPIC EXTRACTION OF FOREIGN BODY – A 3.7mm diameter flexible nasal endoscope attached to the video system is used in this technique. Once the nasal foreign body is located in the camera or video, the scope is made to travel towards the nasal foreign body. The hook-like small projection of the endoscope bypasses the foreign body then again rotated to successfully extract or pull the nasal foreign body out of the cavity.

All of the above methods are done according to the experience of medical professionals keeping in mind the location, extent or depth at which the foreign body is lodged within the nasal mucosal cavity.

Prevention is better than cure. Parents should be aware of their child picking up unwanted, unhealthy objects into the nose and mouth. They should be alert, always around them to prevent such accidents in children.