Experience Summary

In this 360-degree video, observe the examination of the anterior nose using a Thudichum speculum, and the technique to remove a nasal foreign body.

Clinical Context

The removal of a nasal foreign body is a common procedure in both emergency and ENT clinical settings, particularly in young children. Foreign bodies in the nose are typically inserted by the patient themselves, most often by curious toddlers and preschool-aged children. Common objects include beads, buttons, food items, paper, foam, or small toys. In adults, nasal foreign bodies may occasionally result from trauma, insertion for recreational purposes, or accidental inhalation.

Children with a nasal foreign body often present with unilateral nasal obstruction, foul-smelling nasal discharge, nasal bleeding, or, in some cases, visible foreign material at the nostril. Occasionally, the foreign body is asymptomatic and only discovered during routine examination. Organic materials, such as food or plant matter, are more likely to cause an inflammatory response, leading to infection and significant nasal discharge.

Timely removal of the foreign body is important to prevent complications such as local trauma, nasal septal perforation, infection, sinusitis, or aspiration into the airway. Removal is usually attempted in the outpatient or emergency setting, using simple tools such as nasal hooks, suction catheters, or forceps under direct visualisation with a headlight or nasal speculum.

In cooperative patients, the procedure is generally quick and well-tolerated. However, young children may require additional measures to ensure the procedure is performed safely, including parental assistance with immobilisation, distraction techniques, or, in some cases, removal under general anaesthesia if initial attempts fail or if the foreign body is deeply embedded.

Key Points for Clinicians to Discuss with the Patient and Their Family Before the Procedure

1. Explanation of the Problem: Clearly explain that there is a foreign object inside the child’s nose, which may be causing discomfort, nasal discharge, or other symptoms. If the object is visible, show the family its location using diagrams or models if helpful.
2. Description of the Procedure: Explain how the foreign body will be removed using small instruments through the nostril, without the need for cuts or invasive surgery. Reassure the family that the procedure is commonly performed.
3. Expected Sensations: Inform them that the child may feel brief discomfort, and they may sneeze or cry during the procedure, but it is generally quick.
4. Risks and Complications: Discuss possible minor risks, such as nosebleeds, brief discomfort, or, rarely, failure to remove the object, requiring referral to ENT or removal under general anaesthesia.
5. Benefits of Removal: Emphasise that prompt removal prevents infection, further discomfort, or more serious complications.
6. Consent and Questions: Allow time for the family to ask questions, address concerns, and obtain verbal consent before proceeding.

Learning Outcomes

1. Observe the examination using a Thudichum nasal speculum
2. Observe the removal of a nasal foreign body
3. Learn how to counsel a family of a child with an nasal foreign body.
4. Understand the equipment required for the removal of a nasal foreign body

External Resources

• StatPearls - Nasal Foreign Body
• ENT-UK Global Guidelines
• Nasal anatomy