Nasal Foreign Body

A 3-year-old presented to the emergency department (ED) with a “googly eye” in her nose. The child alerted her mother to this interesting nasal complaint after working on craft projects earlier in the day. She was brought to an Urgent Care where attempts to remove the foreign body were unsuccessful, resulting in a referral to the ED for otolaryngology (ENT) evaluation.  Mother denied nosebleed or drainage. The child had not demonstrated any cough, wheeze, or other respiratory symptoms. Her Wispr anterior rhinoscopy (nose) exam is shown.

True or False

Nasal foreign bodies are most likely to become lodged on the floor of the inferior turbinate or anterior to the middle turbinate.

Nasal foreign bodies (FBs) are a very common chief complaint, particularly among young children as well as those with developmental disabilities or mental health disorders. While nasal FBs have the potential to migrate posteriorly, the majority become stuck at the level of the inferior turbinate or anterior to the middle turbinate. The child in this case had a googly eye stuck on the nasal passage floor, pinched between the nasal septum, and a somewhat swollen inferior turbinate.

Several removal techniques have been described including the use of a balloon-tipped catheter, micro-alligator forceps, suction, or an L-hook tool.  Successful removal requires an organized approach with an assistant and parent taking part to minimize attempts and prevent pushing the FB deeper which risks causing the nasal FB to become a more serious airway FB. 

The child in this case was positioned seated on her mother’s lap, facing outward.  This allowed the mother to provide a comfortable hold, gently hugging her child’s arms. An assistant stood slightly to the side of the mother and placed both hands on either side of the child’s head for additional security. Using the Wispr as a light source and for direct visualization, a balloon-tipped catheter was inserted inferior to the FB, inflated, and removed without difficulty. 

Key Learning Points

1. Foreign bodies are common in children in both the nose and ear.
2. The majority of nasal foreign bodies become stuck at the level of the inferior turbinate or anterior to the middle turbinate.
3. Proper removal of a foreign body requires good visualization and the selection of a proper tool.

References:

Baranowski K, Al Aaraj MS, Sinha V. Nasal Foreign Body. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.

Hira İ, Tofar M, Bayram A, Yaşar M, Mutlu C, Özcan İ. Childhood Nasal Foreign Bodies: Analysis of 1724 Cases. Turk Arch Otorhinolaryngol. 2019 Dec;57(4):187-190.