If you are a parent, you have often witnessed (first hand) or heard stories of young children putting objects in their nose, besides their finger. My first encounter with the nasal foreign body issue was in pediatric residency where I was getting a history from a mother about her son. She mentioned that he smelled terrible and it was difficult for her to get near him. He just looked dejected on the examining table, looking downward. She mentioned that he may have put something in his nose. So, I began to examine him and realized that he did have something in his nose. After questioning the boy, he soon admitted that he had placed a piece of hamburger in his nose…2 weeks ago! We soon removed the object and both he and his mother were very happy. He sheepishly promised that he wouldn’t put anything into his nose again.
Since that encounter, I have had the good fortune to find many treasures in noses, from colorful beads to nuts to Lego pieces. I once removed a stone from a toddler’s nose. I asked him why he put the stone in his nose. He mentioned that it looked like a heart and he wanted to give it to his mother. He wanted to keep it in a safe place, so he put it into his nose. The funny thing was that we removed it and it actually did have the shape of a heart! However, aside from this story, we often never discover the reason that the object was placed into the nose and usually focus on the object’s removal. There are several major techniques we use to remove nasal foreign objects.
The first technique is something that we have the parents perform. It is called the “Angel’s Kiss” (sometimes called “Mother’s Kiss” or “Parent’s Kiss”). It is usually performed when the object completely occludes the nasal passage, so any forceful gust of air will be able to push it out. We ask the parent to put their mouth over the child’s mouth and we cover put pressure on the outside of the patent nasal passage to occlude the nare without the foreign object in it. We then ask the parent to blow into the child’s mouth and the force of air pushes the foreign object out of the nose. This is usually the most tolerated procedure with young kids and the least invasive. The other removal techniques usually require more skill and are a bit scarier for young kids.
The more invasive removal techniques include equipment, like forceps, to remove the object. However, this is will require an edge or place to grab onto the object. It is difficult to remove spherical objects with this technique because the forceps cannot grasp the object often slips out of the grasp of the forceps. Another, more gentle, technique involves the placement of a catheter or a tube with an inflatable balloon on the end of it. This is great for spherical objects and is usually the best method for objects in the nose that are not completely blocking the nasal passage, where you can see a small space around the object. With that said, the catheter or tube is placed through the open space between the object and the inside of the nasal passage. The balloon tip is placed just beyond the object. Then, the balloon is inflated and the catheter or tube is pulled out of the nose. The inflated balloon is usually able to push the foreign object out of the nose from behind it, as the catheter or tube is being removed. It is pretty slick and usually tolerated well. It can be performed in a matter of seconds.
What is the most interesting thing that you’ve seen a child put in their nose?
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