Persistent foul-smelling purulent unilateral nasal discharge in a young child without other respiratory symptoms should raise suspicion for a retained nasal foreign body, even without a history of witnessed foreign body insertion.
- Button batteries and paired disc magnets can cause serious damage to nasal structures and merit urgent removal
Visualization of the foreign body (FB) establishes the diagnosis
- Rigid or flexible fiberoptic endoscopy may be necessary to identify some FB
- Plain radiographs can establish the presence of button batteries or magnets within the nasal cavity when suspected but are not necessary for the diagnosis of other types of intranasal FBs
Nasal foreign bodies can often be removed in the office with a nasal speculum and Hartmann nasal forceps
- Prior to removal, the provider may consider using oxymetazoline drops to shrink the mucous membrane
- Indications for otolaryngology referral may include non-visualized posterior FBs, impacted FBs, or unsuccessful initial attempts at FB removal
Viral URI does not present with foul-smelling nasal discharge.
Acute sinusitis may present with purulent nasal discharge, but the observation of a bright light reflection suggests a foreign body.
Allergic rhinitis is seasonal, associated with sneezing and other allergy-related symptoms.
Nasal foreign body