It's always nice when a child is old enough to explain where it hurts or describe just how he managed to stick that small toy in his ear or nose. So, it was very helpful when my 3-year-old patient pushed a small plastic coin up his right nostril one lazy Saturday morning, then immediately told his mom about the deed.
His mother could see the object in the boy's nose, but did not feel comfortable taking it out at home. The pair came into the office where, with the help of my handy forceps, I was able to easily reach the tiny coin about halfway up the child's nostril.
Mission accomplished, I thought, as mom and I congratulated ourselves on handling this minor problem so efficiently. But knowing that kids who put household objects in their body cavities tend to be repeat offenders, I decided to inspect the left nostril as well. It was all clear.
On a look back at the right nostril, I saw a second tiny play coin taunting me from where it sat wedged high up in the nasal passage. I attempted a second retrieval, but was unable to reach the coin with the tools at hand. Luckily, a skillful otolaryngologist was still in his nearby office, and he successfully removed object No. 2 from the boy's nose.
After all that, I'm sure the little guy will never put anything up his nose again, but his case is really not all that unusual. While nasal foreign bodies rarely are an issue in the adult world, they are frequently seen in the pediatric population.
Nasal foreign bodies that are quickly and easily removed generally don't cause problems for children. An item that lingers in the nose undetected can cause unpleasant symptoms, and classically presents at some later date as an unexplained chronic, thick and foul-smelling discharge coming from only one nostril.
In their review article in the journal American Family Physician, Drs. Steven Heim and Karen Maughan report that the most common foreign bodies found in little nostrils are beads, buttons, toy parts, pebbles, candle wax, food, paper, cloth and button batteries.
If a child with a nasal foreign body is old enough and, more importantly, cooperative enough, a parent can instruct him to block the other nostril and attempt to gently blow the object out of the affected nostril. If this is not practical, but a parent is able to see the object close to the nasal opening and feels she can remove it in one piece without traumatizing the child or his nasal tissue, removal can be performed at home.
When it looks like home foreign body removal cannot be performed easily and without complication, it's always best to leave the object where it is and seek prompt medical attention. And while it's generally a good idea to remove all nasal foreign bodies as soon as possible, parents should also be aware that a button battery in the nose requires immediate removal and should always be treated as a medical emergency.
Researchers Alice Guidera and Hans Stegehuis find in their work published in the New Zealand Medical Journal that though a button battery is lower on the list of possible nasal foreign bodies in children, it remains the one object most likely to lead to serious medical complications unless it is rapidly removed.
Lodged button batteries can create electrical and thermal burns in the nose, and can also cause chemical burns if the battery contents leak. The New Zealand authors note that, ideally, nasal button batteries should be removed within 90 minutes of insertion. The longer the battery is in the nose, the higher the risk of injury to the nasal lining as well as actual perforation of the middle septum that divides the two nostrils.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.