PANCE Blueprint EENT (7%)

Nasal foreign body (ReelDx)


4 y/o with foul odor from nose for 2 weeks

Patient will present as → a 4-year-old boy with unilateral purulent, foul-smelling nasal discharge for three days. The child has no other respiratory symptoms.

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

Question 1
A 4 year-old boy presents with purulent, foul-smelling nasal discharge for three days. He has not had any other symptoms of respiratory illness, cough, wheeze, or fever. His activity level and appetite has been normal. On exam, he is afebrile. TM's have normal light reflex, canals are clear. Left nare is clear; there is considerable amount of purulent exudate from the right nare, and a bright reflection of light is noticed. Oropharynx is without inflammation or exudate. Neck is supple, without lymphadenopathy. Lungs are clear, with equal breath sounds and no wheezing. Heart has regular rhythm without murmurs. Which of the following is the most likely diagnosis?
Viral URI
Viral URI does not present with foul-smelling nasal discharge.
Acute sinusitis
Acute sinusitis may present with purulent nasal discharge, but the observation of a bright light reflection suggests a foreign body.
Allergic rhinitis
Allergic rhinitis is seasonal, associated with sneezing and other allergy-related symptoms.
Nasal foreign body
Question 1 Explanation: 
Nasal foreign body is suggested by unilateral nasal obstruction or discharge .
There is 1 question to complete.
Shaded items are complete.

References: Merck Manual · UpToDate

Acute and chronic sinusitis (ReelDx + Lecture) (Prev Lesson)
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