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Nose Foreign Body The nose is a surprisingly deep space that extends directly back into your face. A relatively small portion of the nasal cavity is visible by looking into the tip of the nose. In the back of the nose, the space turns downward and connects to the back of the mouth. Common objects found in noses include food material, tissue paper, beads, toys, and rocks. Most cases of foreign bodies in the nose and nasal cavity are not serious and occur in toddlers and children from 1-8 years. Because children develop the ability to pick up objects at about the age of 9 months, this problem is much less common before then. An object that is simply stuck in the nose and not causing other symptoms can usually wait until morning or the following day for removal. The object does, however, have to be completely removed quickly and without discomfort and danger. Nose Foreign Body Causes The vast majority of foreign bodies are placed in the nose voluntarily for an endless variety of reasons. When questioning children about this possibility, it is important to approach them in a nonjudgmental manner. Otherwise, you run an increased risk that the child will deny having put something in their nose to avoid punishment. This could easily result in a delay of its discovery and increase the risk of complications. Trauma is another common cause for items to get shoved inside the nose. When you fall or get struck in the face, it is important to consider the possibility that an object may be stuck in the nose and be completely out of view. Nose Foreign Body Symptoms Typically, foreign items in the nose result in complaints of pain or difficulty breathing through that side of the nose. Nasal bleeding is also a common symptom because the tissues of the nose can be easily scratched. Much of this blood can drip down the back of the throat and be swallowed. Because blood is quite nauseating, you may vomit, which can appear black or bloody, depending on how long the blood remains in the stomach. The nasal space connects to the back of the mouth, so it is also possible for an object to be pushed back into the throat. You may swallow the object or choke on it. Complaints of choking, wheezing, difficulty breathing, or inability to talk should prompt an evaluation of the entire nose and throat in addition to the lungs so that foreign bodies will not be overlooked. Someone who is motivated to place something in their nose might also think it is fun to put something in the other side of their nose as well as in 1 or both ears. A doctor will check all the likely places. Infection is another common complaint. Lost or forgotten tissue paper is a common source of such a problem. This scenario is not uncommon in adults and children. People will typically complain of continuing nasal discharge from the 1 side of the nose. Many of these people have been treated with 1 or more antibiotics. Unfortunately, antibiotics alone will not cure this condition until the offending object is removed. In addition, your sinuses are all connected to the nasal passages. Because a foreign body in the nose will frequently get infected and block the drainage sites of the sinuses, sinusitis should also raise the question of a foreign object inside the nose. Although you can usually sense the presence of something out of the ordinary in your nose, it may be confused with nasal congestion, so small objects or torn tissue paper can easily go undetected. The skin under the nose may become raw from the continuous discharge or from frequent wiping. Impetigo is an infection of the skin that is commonly associated with this problem. Impetigo typically appears as a raw rash with faint yellow, crusty material over it. Impetigo just in this area must prompt a thorough evaluation of the nose to ensure that the nose is clear. When to Seek Medical Care When to call the doctor Most objects that become lodged in the nose should prompt a call to a doctor. If this object is well defined such as a bead or pebble and is successfully removed at home without difficulty, an immediate doctor!!!s visit may not be necessary. If there is any concern that a portion of the object remains in the nose or nasal bleeding continues, a thorough exam should be performed by a qualified professional. Persistent pain, bleeding, or discharge from the nostril should raise your concern that the nasal passages have not been completely cleared. Many objects remain in the nose and cause few symptoms. A rash below one nostril or unexplained, continuing sinus pressure should also prompt a thorough evaluation. Depending on your particular medical community, your doctor may wish to see you in the office or refer you to a local emergency department or other specialist. Do not expect any health care professional to be able to assess the situation adequately over the phone. If there is any concern for the presence of a foreign body in the nose, the person should be physically examined by a qualified medical professional. When to go to the hospital In the majority of cases, the situation of a foreign object stuck in the nose will not be life threatening. You will have time to call your regular doctor. The urgency of the situation primarily depends on the location of the object and the substance involved. If the foreign body has been inhaled into the persons throat and the person is choking, emergency care is needed. If the object falls back into the throat and is swallowed, see a doctor for emergency care. A few of these objects can become lodged in the esophagus. If this occurs, the object will need to be either pushed down into the stomach or pulled out by a gastroenterologist. An object that contains chemicals, such as button batteries, or the presence of food material also represents a more urgent situation. Because the nasal passages are moist, objects such as beans will swell if they remain in a moist environment. This situation may result in increasing discomfort and more difficult removal of the object. Batteries can decompose enough in the body to allow the chemicals to leak out and cause a burn Exams and Tests Most objects can be seen with good lighting and a few instruments. If there is concern about an object deep inside the nasal passages or complications of a serious sinus infection, an exam with a fiberoptic camera or CT scan may be considered. Occasionally, an object is discovered accidentally when x-rays are taken for unrelated reasons. It is important to realize that many materials such as food, wood, and plastic will not be visible on a routine x-ray. Ask your doctor to examine the entire head and neck region. It is distinctly possible that the person has multiple foreign bodies in both nostrils and in 1 or both ears. Nose Foreign Body Treatment Self-Care at Home It is not advisable to stick anything in the nose while attempting to remove an object there. You may complicate matters by pushing the object farther back into the throat and possibly choking. A few techniques can be tried safely at home to remove the object. Blowing your nose will potentially dislodge the object and is more likely to succeed if the uninvolved nostril is closed during such attempts. Hold your nostril closed by pressing a finger against the side. A sneeze will actually produce much more force and is an alternative way to push the object forward and out of the nose. Again, it is more effective if the uninvolved nostril is closed. Smelling pepper has been described as a safe way to induce sneezing, but individual responses are quite variable. Many people with foreign bodies in the nose are too young to cooperate with these techniques. A parent or caregiver can attempt to remove the object by sealing their mouth over the child!!!s mouth and closing the unaffected nostril with their fingers. Blowing a quick puff of air into the child!!!s mouth has frequently resulted in the object coming out the nostril onto the caregiver!!!s cheek. The child will reflexively protect their lungs, but one should not deliver a large, forceful breath. It is recommended that this technique be done under the supervision of a medical professional. The potential for spread of infection between the child and caregiver should be considered because there may be contact with the child!!!s nasal secretions or blood or both during this maneuver. Nasal bleeding is a commonly associated complaint. Some episodes of bleeding will stop on their own. Gently placing a towel over the end of the nose is a safe way to contain the associated mess as long as the person can breathe easily. If the bleeding does not stop within 5 minutes, seek medical advice. Although the most common recommendation for nasal bleeding (nosebleed) is to pinch the soft part of the nose for 10-15 minutes, this technique may not be appropriate depending on the circumstances and object involved. The common home remedy of placing an ice pack behind the persons neck is not likely to be effective. Placing a cool compress on the nose itself may occasionally decrease bleeding and has the added benefit of reducing swelling, which may aid in the eventual removal of the object. If there is any question about objects in the nose and medical attention is sought, the person should not be given anything to eat or drink until approved by a doctor. The reason for this inconvenience is that some objects are difficult to remove. Sedation is occasionally needed, Medical Treatment Treatment will largely depend on the location and identity of the object or objects involved. Do not be surprised if your doctor uses his or her own unique technique to remove an object. Years of experience often provide innovative techniques that are safe and effective. Commonly used techniques include applying gentle suction to the object, long tweezers, or instruments that have a loop or hook at the tip. If the object is metallic, a long instrument may be magnetized to assist in gently pulling the object from the nose. Another technique involves gently passing a soft rubber catheter past the object. These catheters have an inflatable balloon at the tip, which can then be inflated and pulled back, along with the foreign body. Any experienced professional can tell you that children typically struggle with these techniques. Struggling will decrease the likelihood of success and increase the likelihood of complications. Sedation may be considered an option to allow calm and comfortable removal of the object. Follow-up A repeat exam after removal of an object from the nose is usually recommended. If the person has no symptoms, this exam can be done in a regular clinic within 1 week. If there is any continuing drainage, bleeding, or discomfort, a thorough exam by a qualified medical professional is imperative. With calm and careful treatment, this condition should be the source of entertaining memories and not serious health problems Prevention Curiosity and exploration of one!!!s body is a natural stage of development. Teaching a child that it is not good to put anything inside the nose may prevent some of these mishaps. If you suspect a child has inserted something into his or her nose, it is important to approach these situations in a nonjudgmental manner, so that the objects can be discovered and safely removed before complications develop