Foreign bodies in the nasal cavity are a commonly encountered scenario in the pediatric population. They are seen less often in adults, but when seen, they are more common in those with psychiatric illness or cognitive delays.

The most commonly encountered foreign bodies include inorganic beads, plastic toys, and other household items, as well as organic material such as food. Rarely, an ectopic tooth may be seen. Organic nasal foreign bodies often become more symptomatic than inorganic foreign bodies. Disk (coin or button cell) batteries may also pose the risk of a chemical burn.

Nasal foreign bodies usually present with nasal discharge (clear, bloody, or purulent), sneezing, unilateral nasal obstruction, and a sensation of a foreign body in the nose. It presents less commonly with pain of the nasal cavity or coughing. In many cases, the patient admits to or is witnessed inserting a foreign body into the nasal cavity. Some patients may be entirely asymptomatic. In some cases where the diagnosis is delayed, it may be suspected due to unilateral nasal discharge that begins as clear or bloody mucus. Over time, as infection develops, the discharge turns purulent and halitosis may develop. This may be accompanied by a fever or respiratory symptoms including cough, wheezing, or stridor.

Retained nasal foreign bodies may cause mucosal inflammation and damage leading to other complications including acute otitis media, sinusitis, epistaxis, periorbital cellulitis, tissue necrosis, and nasal septal perforation (seen more with disk batteries and magnets). Rarely, foreign bodies may also dislodge and become aspirated, causing respiratory compromise. Rare cases of toxic shock syndrome and tetanus have been reported related to long-standing nasal foreign bodies.

Related topic: foreign body aspiration