Nasal foreign bodies in the paediatric emergency department

Background: Nasal foreign body(-ies) (FB) cause local irritation, inflammation, and mucosal erosion and carry a potential risk of aspiration. The aim is to describe the management of nasal FBs in our Emergency Department (ED). Method: A retrospective study of 100 sequential suspected nasal FB presentations to a tertiary paediatric ED. Patient age, gender, FB typology, doctor/nurse seniority, sedation/analgesia usage, removal method, ENT referral rate, extraction time and disposition were collected. Data was inputted to Microsoft Excel®. Results: One hundred cases were encountered over 16 months: 51 males and 49 females. Median age was 3.4 years (range 0.8–10). Of the 73 FB visualised in the ED, 78% (57/73) were successfully removed by ED staff. Sixteen visualised in ED required ENT removal. Of those 16 FBs, 7 were removed at OPD while 9 were removed by ENT in ED. Discussion: The ED physician/advanced nurse practitioner successfully managed most children with a nasal FB in the ED. The goal of the management should be to minimise complications/repeated attempts. Formation of a national guideline to assist in ED removal and timely care will hopefully improve patient’s experience. It will include guidance on topical anaesthetic use, performing radiographs for radiopaque objects not initially visualised and limiting ED staff extraction attempts.