Nasal foreign bodies are found occasionally in young children, the intellectually impaired, and psychiatric patients. Common objects pushed into the nose include cotton, paper, pebbles, beads, beans, seeds, nuts, insects, and button batteries (which may cause chemical burns). When mineral salts are deposited on a long-retained foreign body, the object is called a rhinolith.
A nasal foreign body is suspected in any patient with a unilateral, foul-smelling, bloody, purulent rhinorrhea. Diagnosis is often made through another party’s observation of the item being pushed into the nose or through visualization with a nasal speculum.
Nasal foreign bodies can sometimes be removed in the office with a nasal speculum and Hartmann nasal forceps. Pretreatment with topical phenylephrine may aid visualization and removal. To avoid pushing a slippery, round object deeper, it is better to reach behind the object with the bent tip of a blunt probe and pull it forward. Sometimes, general anesthesia is necessary if a rhinolith has formed or if the foreign body may be displaced dorsally and then aspirated, resulting in airway obstruction.