Issue: August 15, 2006
Case: Disorders of the Nose
Taken from
Med-Challenger EM Career
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Question:
A child presents with a complaint of persistent foul-smelling
unilateral nasal discharge. Examination reveals a foreign body.
All of the following are appropriate treatments EXCEPT:
Answer Options:
- Use suction secretions and instill a topical vasoconstrictor (e.g., 1% phenylephrine) to shrink the mucosa, effectively loosening the FB.
- Use a hooked instrument to pull out rounded objects.
- Use a bayonet or alligator forceps to grasp and withdraw irregular
objects.
- An object which cannot be brought out anteriorly may be pushed back into
the oropharynx and retrieved with Magill forceps.
- Otolaryngologic consultation may be necessary for difficult cases.
Answer:
D
Remediation:
Pushing an object back towards the pharynx risks aspiration.
Button batteries lodged in the nose or ear canal have been
reported to cause tissue necrosis and should be removed
immediately [McRae D 89].
Live insects in the external ear canal are a common problem, and
can cause severe patient agitation. Fill the canal with
microscope oil, mineral oil, or 2-4% lidocaine to stupefy the
insect. Then flush it out with a syringe and catheter, Water-Pik,
or extract with bayonet forceps.
Insufflation via the mouth can often dislodge
fairly stubborn nasal foreign bodies. It works much better after
topical vasoconstrictor use. Simply occlude the unaffected
nostril, and have a parent give what would typically be a single
rescue breath. Typically the foreign body, along with a copious
supply of purulent mucous, is rapidly dislodged.Removal of
ear foreign bodies in small children may be greatly facilitated
with procedural sedation. While occasionally successful, use of
superglue or tissue adhesives is often time consuming and simply
results in gluing the applicator to the surrounding tissue. In a
cooperative patient with a dry round foreign body in the ear, it
is a reasonable method, although snipping the tip of a red robin
catheter and attaching it to low suction often will be quicker.
About the Image(s):
Image 1: Lillie Hook
A Lillie hook is a useful foreign body extraction
device for both nasal and otologic foreign bodies.
Image 2: Lillie Hook (Close-up)
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