Objects stuck in the nose, ear, or other orifices

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Objects that become stuck in a child’s nose, ear, or other orifice are called foreign bodies. A number of different foreign bodies can easily become lodged in these orifices due to young children’s curiosity and their misunderstanding of the danger of small objects.

The presence of foreign bodies in the nose or ear is generally less serious than foreign body aspiration or ingestion, i.e. when objects get swallowed and stuck in the airway or gastrointestinal tract. However, certain objects can cause significant damage to the delicate internal structures of the nose and ear and must be removed carefully.

This article discusses the types of foreign bodies that can become lodged in a child’s nose, ears, and other orifices, as well as the associated dangers and extraction methods.

Intranasal foreign bodies

Foreign bodies that become lodged in the nose are called intranasal foreign bodies. More foreign bodies are retrieved from the nasal passage than all other aerodigestive tracts combined. Toddlers and preschoolers are most likely to exhibit intranasal foreign bodies, but older children and adolescents with intellectual or behavioral disabilities may also, although less commonly.

Due to the fact that most children are right-handed, the majority of foreign bodies become lodged in the right nostril. Both food items and inorganic objects are placed inside the nose, but the most dangerous objects are button batteries and paired disc magnets.

These can cause significant damage to the internal structure of the nose. Button batteries are dangerous due to their strong electrical currents and can cause septal perforation in less than 4 hours. Paired disc magnets are often found on jewelry and can be so strong that they cannot be manually separated when placed in the nostrils. Over a number of weeks, this can cause chronic compression of the septum.

Common intranasal foreign bodies include:

• Beads
• Pearls
• Pins
• Nails
• Paper
• Stones
• Rubber
• Small toys
• Crayons
• Chalk

As well as food items such as:

• Peas
• Beans
• Seeds
• Carrots
• Meat
• Candy
• Apples
• Chewing gum

Signs and symptoms of intranasal foreign bodies

• History of nasal foreign body insertion
• Nasal discharge of mucus and pus
• Foul odor
• Nosebleeds
• Nasal obstruction
• Mouth breathing
• Sneezing

Most intranasal foreign bodies are inorganic and can cause pain, inflammation, and infection. Facial swelling accompanied by fever may also occur.

Intranasal foreign body removal

Intranasal foreign body extraction is an elective procedure unless the object is particularly dangerous and prone to causing damage (e.g. button batteries, magnets). Foreign bodies can be removed from the nose by pediatric emergency clinicians and do not usually warrant referral to an otolaryngologist.

If the extraction is performed incorrectly, the foreign body can be aspirated and become lodged in the child’s airway. This is a rare occurrence, however, and an analysis of 60 cases of intranasal foreign bodies found that 98 percent were successfully removed by emergency clinicians.

The procedure can involve either positive pressure techniques or instrumentation, depending on the type of foreign body and its location. Smooth or soft objects may be removed by having the child blow their nose while the unaffected nostril is blocked off. This channels more air pressure on the foreign body which can force it out of the nose.

If positive pressure techniques are unsuccessful or the foreign body warrants a different approach, instrumentation may be used to manually remove the object.

Foreign bodies in the ear

Foreign bodies can affect both the outer and inner ear. Foreign bodies in the ear canal are usually more serious as they can cause bone fractures and hearing damage.

Foreign bodies of the outer ear can become lodged in the earlobe, cartilage, and external auditory canal. The most common foreign body injury of the outer ear involves embedded earrings in the lobe or cartilage. This is most common in girls under 10 years of age and adolescents [7].

Middle ear injuries involving foreign bodies are more dangerous. Foreign bodies inserted into the ear can penetrate the ear canal, the eardrum, and the middle ear [8]. This can result in eardrum perforation, hearing damage, hearing loss, or dislocation of the ossicles — the small bones of the middle ear. The removal of foreign bodies from inside the ear must be performed properly and carefully to avoid pushing the object further into the ear and inflicting further damage.

Common foreign bodies found in ears include:

• Toys or small objects
• Pieces of food
• Insects
• Button batteries

As mentioned above, button batteries are one of the most dangerous intranasal foreign bodies due to their strong electrical currents. The same can be said for button batteries placed inside the ear. They pose a significant risk of causing extensive damage to the middle and inner ears as well as adjacent structures. Their electrical currents can cause severe burns while the caustic fluid in the battery can leak into the ear. Button batteries must be removed immediately as damage can occur rapidly.

Signs and symptoms of foreign bodies in the ear:

• Pain
• Itching
• Otorrhea (ear discharge)
• Ear blockage
• Reduced hearing

Removal of foreign body from the ear

An embedded earring in the outer ear should be removed using local anesthesia and sterilized surgical tools. This can be performed by emergency clinicians. For foreign bodies of the middle and inner ear, an otolaryngologist should carry out a careful assessment of the object before performing the extraction using a microscope.

Foreign bodies in other orifices

As well as the nose and ear, foreign bodies can become lodged in other orifices such as the rectum or vagina.

Common foreign bodies include:

• Toilet paper
• Small toys
• Hairbands
• Paper

Button batteries are a rare but dangerous foreign body that can cause deep vaginal burns or vaginal perforation, warranting immediate removal. Signs of an intravaginal button battery include pain and grey, watery discharge.

Signs and symptoms of intravaginal foreign bodies

• Chronic discharge
• Intermittent bleeding or spotting
• Foul-smelling odor