Nasal foreign bodies (NFBs)
Doctors often have to meet with nasal foreign bodies, but there is no summarizing data on this issue. In the literature describes only a few cases (without the emphasis on physicians errors). Nasal foreign bodies occurs predominantly in young children, and therefore errors are more common in pediatric otorhinolaryngology.
Foreign bodies fall into the nasal cavity often through the right half. They need to look for especially in the inferior nasal passage, rarely — in middle, even less — in the superior part. Sometimes, negligently, after surgical procedures foreign bodies appear in the nasal cavity (pieces of cotton wool, swabs, pieces of surgical instruments).
Through the posterior nasal apertures (choanae) foreign bodies can get into the nasal cavity during vomiting (usually this happens if the soft palate paralysed and in various palate congenital anomalies). Foreign bodies can get into the nasal cavity by trauma (when violated the integrity of the walls of the nose), but even in children this way is extremely rare.
Ways of getting foreign bodies in nasal cavity:
- Introduced into the nasal cavity by the victim himself
- Introduced into the nasal cavity by foreign hand (during the game, medical manipulations)
- Accidentally got in the nasal cavity (through the nasal vestibule, through the choanae)
- Trapped in the nasal cavity with injury
Nasal foreign bodies may be a variety of items: coins, bits of cotton or paper, pencil lead, fruit seeds, beads, small parts from toys, etc.
To avoid confusion, it should be remembered, that in the nasal cavity can be teeth (incisors and canines), which grow there from the tooth germs as a result of inversion (heterotopia).
In the presence of a foreign body in the nasal cavity (usually it's a one-side process) observed difficulty in nasal breathing and purulent discharge from the corresponding half of the nose. Sharp foreign bodies can damage the mucous membrane that is accompanied by nasal bleeding. When finding a foreign body in the middle nasal passage observed loss of smell, watery eyes (due to blockage of the excretory duct of the lacrimal-nasal channel). Long stay of foreign body in the nasal cavity can lead to the development of inflammation of the paranasal sinuses, which will require adequate treatment.
In young children a reliable sign of nasal foreign body are unpleasant odor and purulent discharge from the affected half of the nose. In some cases the diagnosis is quite difficult, and can be erroneous, as in the nasal cavity develop granulation, which mask the presence of a foreign body. The feeling of the metal probe helps to avoid mistakes in the diagnosis of foreign bodies.
Contrast foreign bodies can be detected by radiography, computed tomography. When overgrown granulation in order to avoid errors it is necessary to differentiate them from malignant tumors of the nasal cavity.
The treatment consists in removing foreign body. In the past, doctors widely used sensitive non-instrumental methods of removal. The simplest of them — strong blowing the nose, but this method is applicable only in older children. For younger children performed blowing air into the mouth or through the free half of the nose in a manner Politzer.
The surest way to remove foreign body is instrumental, but it is most dangerous. Produce pre anemisation and anesthesia of the nasal mucosa. Round foreign bodies removed by a special probe with a curved end. Hook slid above and over the foreign body and remove by movement from back to front. Flat foreign bodies easier to remove nasal forceps. Wedged foreign bodies of large size must be pre-crushed and extracted in piecemeal. Inflammation caused by the presense of foreign body, after removing it quickly eliminated. However, prolonged pressure from foreign body on the bones develops osteomyelitis.
For the prevention of foreign bodies is necessary to exclude small objects from the everyday life of young children. Parents and older children need to explain the danger of ingress of foreign bodies in the nasal cavity. Special attention is necessary to prevent the occurrence of foreign bodies in operations on the nose, which, of course, is malpractice, followed by litigation.
Rhinoliths (nasal calculus)
Only some authors consider rhinoliths (nasal calculus) as foreign bodies. Rhinoliths (nasal calculus) is formed by salt deposits from the nasal mucous secretions and lacrimal glands around a long time presens foreign body in the nasal cavity.
The formation of rhinoliths facilitate changes in the nasal cavity (deviated septum, hypertrophy of turbinates) that cause the delay of the mucous secretions. Rhinoliths (nasal calculus) can be of various shapes: oval, round, plate. Sometimes they represent a cast of the nasal cavity. Rhinoliths are often single but may be plural, so to avoid errors you should carefully inspect the entire nasal cavity to the posterior nasal apertures (choanae).
Leading symptoms are unilateral nasal breathing difficulty, and purulent discharge from the corresponding half of the nose. Around rhinolith can thrive granulation. Sometimes there are general effects: headache, poor sleep. The differential diagnosis should be carried out with simple osteomas and foreign bodies.
Rhinolith treatment consists from its instrumental removing, large size rhinolith — surgically removing.
Live nasal foreign bodies
From the live nasal foreign bodies can meet worms (pinworms, ascarids, leeches), insect larvae. Ascarids fall into the upper respiratory tract from the digestive tract with vomiting or crawl there on their own. The children complain of headaches, discomfort in the nose. When the movement and manipulation of the ascarids can get into the sinuses, larynx, trachea and cause asphyxia, death. Ascarids of the nasal cavity is removed with tweezers.
Pinworms, trapped in the nasal cavity from the stomach, destroyed by menthol oil lubricating the mucous membrane of the nasal cavity, then remove it with tweezers.
By drinking water from stagnant water leeches can get into the nasopharynx and from it crawl into the nasal cavity, which is accompanied by bleeding, difficulty in nasal breathing, itching. Leech extract by grabbing with tweezers.
In addition, maggots can enter the nasal cavity, attach to the mucosa by using passivating apparatus and cause its destruction (as well as periosteum and underlying bone); during manipulations the special care is necessary (an opportunity of penetration into an orbit and a brain).
Children complain of headache in the frontal and parietal areas. Some have dizziness, which sometimes leads to diagnostic errors. From the nose there is abundant mucus with blood and an unpleasant smell (it is necessary to exclude a tumor). When the larvae move, irritation of the mucous membrane of the nasal cavity occurs, so children often sneeze, and this can lead to diagnostic errors.
Diagnosis is via the front rhinoscopy, in which the mucous membrane are determined by moving the white maggots. To clarify the diagnosis is necessary the use of optics. Then produce anemisation of nasal mucosa and recovered larvae nose by tweezers.
Nasal foreign bodies symptoms
Summarizing the above, note features of nasal foreign bodies. Sharp objects usually cause pain in the nose and bleeding. Foreign bodies that swell, make breathing difficult and lead to inflammation with purulent discharge. Small foreign bodies with a smooth surface can be asymptomatic for a long time, sometimes get into the nasopharynx, larynx, trachea and bronchi. If the foreign body lingers for a long time in the nose, it becomes the cause of a long rhinitis, the appearance of granulations. On the foreign body and around it are deposited inorganic salts (calcareous and phosphoric), making it look like a stone (rhinolith).
To date, the etiology of rhinoliths remains unclear. Apparently, the reason for their formation is not always the foreign body.
Nasal foreign bodies diagnosis
With unilateral nasal congestion, purulent or blood secretions with an unpleasant odor clarify the anamnesis, produce a rhinoscopy, palpation with a probe, etc. To reduce edema, apply a 0.1% solution of adrenaline. A small foreign body with swollen and bleeding mucosa, when it is surrounded by lush granulations or located in the back of the nasal cavity, is easier to find with the use of optics. Metallic foreign bodies and so-called lost teeth are diagnosed by the method of radiography and computed nasal tomography (CT).
Nasal foreign bodies treatment
Nasal foreign body sometimes moves spontaneously (when sneezing), but usually it is removed instrumentally. In this case, it is necessary to prevent the aspiration of the foreign body into the lower respiratory tract. A small foreign body removed blunt hook, which give birth to him. Removing the produce at the bottom of the nasal cavity in the direction from back to front. It is inappropriate (and in some cases, dangerous) to remove solid foreign body by forceps.
Do not try to remove the foreign body by blowing air ("Politzer's shower) or by pouring water into the intact nasal side. This requires such a high pressure, that it creates a danger of penetration of the discharge from the nose or irrigation fluid into the auditory (eustachian) tubes, resulting in develop purulent inflammation of the middle ear, and the foreign body will remain unremoved. Thus, the requirements, which is required for the removal of foreign body from external auditory canal, in this case incorrect. Do not try to remove the body of a rounded shape with a forceps or tweezers (the attempt will be unsuccessful, moreover, when the branches of the instrument are closed, the round foreign body is moving deeper).
Forceps-like tool removes only the buttons are flat and similar in shape objects (they can be installed in the nasal passage, like the wheels on the machine and compressed with forceps on both sides). The same applies to soft objects - swollen peas, seeds, cotton balls, etc. For the removal of round objects, it is preferable to use a so-called ear spoon or a thick buttoned probe, which is easy to impart a curved shape. With the help of this tool bypass over the object by directing bending spoons or recess behind the object and remove it by lifting up the hand is in the end of the probe or the tool and pushing the foreign body strong movement from back to front. In this case, it is necessary to hold the child tightly. Lubricating the nasal entrance with a 10% cocaine solution greatly facilitates the task, as, on the one hand, the defensive movements of the child are weakened, and on the other, the swollen anterior end of the inferior nasal concha is shed due to the vasoconstrictive action of cocaine.
If the first attempt fails or if the foreign body is large, is deep in the nasal cavity or upper in the middle nasal passage, if it is poorly visible and achievable, the child should not be tormented by extraction. It causes him pain, causes bleeding and greatly complicates the removal of another, experienced professionals who intervene in this situation it is necessary.
In the case of a successful attempt to free the nasal patency is restored, enhanced and modified mucus discharging, swelling and cracks disappear after a few hours or days, without requiring further treatment.