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Foreign body in nasal sinus — Clinical Guidelines

Overview

Nasal foreign bodies occur when objects are inserted into the nasal passages or sinuses, commonly affecting children but also seen in adults, potentially leading to complications if not promptly removed. 1 3

Diagnosis

Clinical Presentation: Often presents with nasal discomfort, unilateral obstruction, or self-reporting of insertion. 1

Common Sites: Predominantly in the right nasal cavity and antero-inferior portion of nasal cavities. 1

Incidental Detection: Asymptomatic foreign bodies can be found incidentally, especially in chronic cases or specific occupational settings (e.g., metal fragments in maxillary sinus). 3

Diagnostic Imaging: Not routinely required but may be used to confirm location and type of foreign body, particularly in complex cases. 4

Management

Initial Removal: Emergency Department physicians often perform removal using simple instruments; multiple techniques may be necessary. 4 5

Nasal Wash Technique: Effective for certain foreign bodies, utilizing readily available equipment for removal. 5

Otolaryngology Involvement: Higher likelihood of referral to otolaryngology for removal in older children, complex cases, or with disc-shaped objects; surgical intervention may be required, especially for button batteries. 2

Complications Monitoring: Close monitoring for complications such as septal perforation, especially with button batteries. 2

Special Populations

Pediatrics: Common in children aged 1-5 years, typically managed with simple removal techniques in ED. 1

Adults: Less common but can involve incidental findings or occupational hazards (e.g., metal fragments). 3

Key Recommendations

Prompt Removal: Nasal foreign bodies should be removed as soon as possible to prevent complications; initial attempts often successful in ED with simple instruments. (Evidence: Strong 4 5)

Referral Criteria: Refer to otolaryngology for removal if the foreign body is disc-shaped, located deeply, or if complications are suspected, especially with button batteries. (Evidence: Moderate 2)

Monitor for Complications: Closely monitor patients, particularly those with button batteries, for potential complications like septal perforation. (Evidence: Moderate 2)

References

1 Yan S, Zeng N, Chen G, Chen Y, Wu Z, Pan H et al.. Presentation and management of nasal foreign bodies in a Chinese metro area. Medicine 2021. link 2 Scholes MA, Jensen EL. Presentation and management of nasal foreign bodies at a tertiary children's hospital in an American metro area. International journal of pediatric otorhinolaryngology 2016. link 3 Enöz M, Selvi F, Inançlı HM, Katırcıoğlu OS, Acar M. Incidentally detected asymptomatic metal foreign bodies (two nails) in shoemaker's maxillary sinus. Kulak burun bogaz ihtisas dergisi : KBB = Journal of ear, nose, and throat 2012. link 4 Chan TC, Ufberg J, Harrigan RA, Vilke GM. Nasal foreign body removal. The Journal of emergency medicine 2004. link 5 Lichenstein R, Giudice EL. Nasal wash technique for nasal foreign body removal. Pediatric emergency care 2000. link

Foreign body in nasal sinus