Removing A Foreign Body From The Nose

Hi again.

One of the most fun things (in my admittedly strange opinion) in practice is removing foreign objects from noses, ears, etc. Kids manage to put the wierdest things in any orifice they can find and get to-- usually ears and noses. I've removed beads, buttons, erasers, bugs, an LED, foam rubber, a doll's eye, and Barbie earrings (two of them, one after the other from the same nostril!). Parents are usually freaked by the occurence, and incredibly relieved afterwards. The kids, of course, could care less-- until you go to remove the object.

There are, of course, real concerns about foreign bodies in the nose. Aspiration of the object into the lungs can occur, causing respiratory compromise. Its important at the outset to take precautions to minimize the chance of that happening. First, DON'T lay the patients down until you've examined them to ensure that there is no airway compromise. Listen for wheezing or "whistling" over the anterior chest, signs that there may be an object in the airway. (I noted this on one child who on bronchoscopy was found to have aspirated a small plastic ring from an artificial flower.)

Then, do your exam to identify the location of the object with the child sitting upright on the parent's lap. Be sure to check BOTH nares, even if the history suggests only one side. Once you have confirmed the presence of the object, prepare everything you need to retrieve it-- lighting, tools, etc.-- before you position the child Often, you can do this by restraining the child on the parent's lap, though sometimes you have to lay them down.

In this case, the foreign object was a small rubber nose from a toy animal that the child had placed in his nose. My partner tried to retrieve it with tweezers, but was unsuccessful. The object was far back in the nose, and wedged against the side of the nostril (a not uncommon finding). This made it difficult to get the forceps on both sides of the object for a good grip, so she couldn't pull it out.

So she called me in to help. After I examined the nose, I had an "Aha!" moment. I went and got one of our new Articulating Safe Ear Curettes. This curette has a moveable tip that is flexed by simply sliding your fingers against each other.

I restrained the child lying down, with his arms straight over his head and having mom hold his elbows against the sides of his head to keep it from moving. (A great technique, by the way.) Then I simply slipped the Articulating Curette past the object, flexed the tip, and pulled it straight out of the nose! Success!! The whole process took about a minute, with no trauma or sedation, and two very happy people afterwards. (Three, if you count my partner.)

Try the Articulating Safe Ear Curette for nasal foreign bodies, or for ear curettage in general. Also, let me know of your experiences (and tips) for removing foreign bodies in kids.

Till next time.


Dr. James Huttner