Nasal foreign body: The Daily PANCE Blueprint
A 4-year-old girl is brought to the pediatric clinic by her father for 5 days of foul-smelling, unilateral purulent nasal discharge from the left naris. She has had two episodes of left-sided epistaxis over the past 3 days. She is afebrile. There is no history of upper respiratory infection, allergies, or trauma. Anterior rhinoscopy reveals mucopurulent discharge obscuring the left nasal cavity. The right nasal cavity is clear. Which of the following is the most likely diagnosis?
A. Acute bacterial rhinosinusitis
B. Allergic rhinitis
C. Choanal atresia
D. Nasal foreign body
E. Juvenile nasopharyngeal angiofibroma
Answer and topic summary
The answer is D. Nasal foreign body
Nasal foreign bodies are among the most common pediatric ENT emergencies, occurring predominantly in children aged 1–5. Common objects include toys, beads, food items, paper, etc. Button batteries and magnets are the most dangerous because they can rapidly cause tissue necrosis. Most foreign bodies lodge in the anteroinferior right nasal cavity. Although many children are initially asymptomatic, the classic presentation is unilateral foul-smelling purulent nasal discharge, nasal obstruction, and recurrent epistaxis. Diagnosis is primarily clinical, based on history and direct visualization with anterior rhinoscopy (aided by topical decongestants and anesthetics). Most cases can be managed safely in the clinic or ER without sedation. The “mother’s kiss” technique is a safe, noninvasive first-line removal method with an approximately 60% success rate. It is performed by having the parent seal their mouth over the child’s mouth, occlude the unaffected nostril, and deliver a short puff of air.
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