• Foreign bodies are a common complaint in pediatric patients
  • Common sites include the ear and nose, as well as the respiratory and GI tracts
  • Common objects include food, paper, beads, buttons, magnets, batteries, pen caps, and small toys (e.g. Legos)

Aural Foreign Bodies

  • Foreign bodies in the external auditory canal may be asymptomatic or cause pain, bleeding, or otorrhea
  • Diagnosis is through visual inspection but may require ENT consultation
  • Complications include otitis externa and perforation of the tympanic membrane

Nasal Foreign Bodies

  • Nasal foreign bodies may be asymptomatic but often cause local irritation
  • Diagnosis is through visual inspection but may require ENT consultation, depending on location
  • They should be suspected in any patient with unilateral purulent nasal discharge

Extraction of Aural and Nasal Foreign Bodies

  • The method of extracting foreign bodies depends on the type of object
  • In the case of both ear and nasal foreign bodies, care must be taken to avoid pushing objects in further
  • “Mother’s kiss”
    • Although the “mother’s kiss” is effective only ~60% of the time, it is worth attempting, especially because it requires no tools (other than a willing participant)
    • This technique consists of the adult placing his or her mouth over the child’s, occluding the unaffected nare, and blowing quickly and forcefully
    • Even if unsuccessful, this technique may be useful to improve visualization of the foreign body
  • Katz extractor
    • Immensely useful for extracting both aural and nasal foreign bodies
    • Consists of a syringe attached to a small balloon catheter that is inserted beyond the object, inflated, and then retracted
    • A small urinary catheter may be used if a Katz extractor is not available

Katz Extractor

  • Alligator forceps
    • Useful for small, irregularly shaped objects
    • May push rounded, smooth objects further in

Alligator Forceps

  • DIY irrigation
    • Irrigation can be a helpful tool for impacted cerumen as well as non-organic objects with the exception of batteries
    • DIY irrigation can be performed with the help of a syringe attached to either an angiocath or a trimmed section of the luer lock portion of a butterfly needle (cut to ~1 inch)

DIY Aural Irrigation

Airway Foreign Bodies

  • Foreign bodies in the airway produce symptoms that vary with the level of arrest
  • Patients may be asymptomatic or have symptoms as described below
    • Objects that obstruct the larynx cause choking and should be addressed with the Heimlich maneuver
    • Objects in the airway that do not cause full obstruction can cause choking, cough, and wheezing
    • Patients may have asymmetric breath sounds if the object is located in one of the mainstem bronchi
  • Diagnosis
    • ABCs are the first priority in these patients
    • Chest radiographs should be obtained, including with PA and decubitus positioning, and may show air trapping, atelectasis, or pneumothorax
  • Management includes bronchoscopy for diagnostic and treatment purposes
  • Complications of airway foreign bodies include pneumonia, abscess, atelectasis, and bronchiectasis

GI Foreign Bodies

  • Esophageal foreign bodies
    • Esophageal foreign bodies often lodge in areas of physiologic narrowing, including the thoracic inlet, middle esophagus (at the crossing of the aortic arch), and lower esophageal sphincter
    • Symptoms include choking/gagging, vomiting, dysphagia, and odynophagia
    • Patients should undergo imaging, including PA/lateral chest radiographs or CT if necessary
      • If parents bring an example of the object, it may be useful to put it on the x-ray plate to determine whether it is radiopaque
      • Button batteries have the characteristic halo on the head-on view and step-off on lateral imaging (see below)
    • Management
      • Emergent endoscopy for: obstruction with inability to tolerate secretions, button batteries in the esophagus, and sharp objects
      • Urgent endoscopy (within 12-24h) for: non-pointed objects including coins, partial obstruction, sharp or large objects in the stomach or duodenum, and multiple magnets because of the risk of erosion in the tissues between the magnets
      • Nonurgent management: objects in the stomach, button batteries in the stomach up to 48h if asymptomatic, or objects that remain in the esophagus for several weeks
    • Medical management is not recommended
    • Complications include mucosal abrasions, lacerations, and necrosis with potential perforation, as well as stricture formation
  • Gastric or intestinal foreign bodies
    • Patients may be asymptomatic, or symptoms may include abdominal pain and vomiting
    • Imaging should include two views (e.g. PA and cross table lateral radiographs) to localize the object in space
    • Most objects will pass spontaneously; see management of esophageal foreign bodies above for caveats

PA and Lateral Views of a Button Battery (credit: REBEL EM)


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