Foreign Objects: Where Did That Bead Go?!
Jana Ghulmiyyah, MD
Pediatric Otolaryngology
Maimonides Medical Center
Fast and curious; two words that can be used to describe little children. They are usually fast to act and are curious to smell, taste or touch objects in their surroundings. Unfortunately, this curiosity will often lead to a foreign body emergency!
Foreign bodies of the ear, nose and throat are commonly encountered in children below the age of 4. Patients with and without Down syndrome are as likely to present with foreign bodies. This article is meant to shed light on these foreign bodies according to location, the risks associated with each and the treatment options.
Ear foreign body:
Children will commonly insert small objects into their ears for various reasons. It may be to hide the object, feel the object or even just for fun!
Ear foreign bodies are usually of smaller caliber and have a harder consistency.
Food items, insects, toys, beads, small crayons, small buttons, or small batteries are commonly retrieved from ear canals.
Common presentations include ear pain, drainage or a foul smell noted by the parents. Older patients may report decreased hearing as well.
What are the risks of ear foreign bodies?
Depending on the size of the object inserted, the ear canal may be lacerated causing infections and/or drainage. Down syndrome patients are known to have narrower ear canals and therefore, are more likely to suffer from traumatic foreign body insertions or retrievals.
If the foreign body is inserted deeper into the ear canal it can lead to perforation of the ear drum and possibly enter the middle ear. Damage to the tympanic membrane or the middle ear contents may lead to temporary or permanent hearing loss.
How are these objects retrieved?
Once identified, the foreign body can be grasped, suctioned or washed out of the ear. The instrument used for the retrieval is dependent on the material of the foreign body and the shape. Younger patients will commonly require general anesthesia as the procedure can be uncomfortable. Patients are also required to sit still while the foreign body is removed which is not always a possibility if they are awake.
What can parents expect after retrieval?
In most instances, surgery for ear foreign body removal is a same day surgery. In patients with a canal injury, antibiotics drops are usually prescribed. In more severe cases in which the tympanic membrane is perforated, further surgical intervention may be required.
Nose foreign bodies:
Some children might also be tempted to insert different objects into their nasal cavities to hide them or while trying to smell them. These are commonly soft in nature unlike foreign bodies encountered in the ear.
Tissue, clay, pieces of toys, erasers or button batteries are commonly encountered in the nasal cavity.
The patients may present with pain or foul-smelling colored secretions from one side of their nose.
What are the risks of nose foreign bodies?
Nasal foreign bodies can commonly cause infections. Given their softer nature, they are less painful and may take longer to discover. They can occasionally cause nose bleeds during insertion. Button batteries are the most aggressive and can cause damage to the surrounding tissues and therefore need to be removed urgently.
How are the objects retrieved?
The patients will usually need to be examined in an ENT clinic. Occasionally they can be removed in clinic, however younger children will commonly require general anesthesia. The nose is examined while the patient is asleep and different instruments including suction or a curette may be used to remove the foreign body. Nasal endoscopy may sometimes be used to examine the nasal cavity more accurately.
What can parents expect after retrieval?
Patients with nasal foreign bodies can most likely go home after retreival. They may be prescribed nasal irrigation or antibiotics depending on the resultant damage to the nasal mucosa.
Throat foreign bodies:
The third and last location a foreign body can be misplaced is the most dangerous of all. A foreign body in the throat can go down the food tract (esophagus) if a child tries to eat it. More importantly, it can go down the windpipe (trachea) if they choke on a food item or if they inhale it accidentally. Some of the common foreign bodies found in the esophagus are food molecules that are too large, coins or batteries. Examples of foreign bodies found in the trachea are peanuts, popcorn, other small food items, small toys and batteries. Patients with an esophageal foreign body will present with difficulty swallowing, drooling and occasional chest pain whereas patients with a foreign body in the trachea will have difficulty breathing, noisy breathing and possibly bluish discoloration! If you witness your child choking or having any of the above symptoms please know it is an emergency and you need to act promptly!
What are the risks associated with throat foreign bodies?
Foreign bodies in the food tract can lead to difficulty eating and swallowing. They can cause significant pain. If left in the esophagus for too long, the foreign body can cause a perforation in the wall of the esophagus. The button battery is the most likely foreign body to present with a perforation due to a reaction in the surrounding tissues and may lead to dangerous outcomes. A foreign body in the airway can block off air from entering the lungs properly and cause drops in the patients’ oxygen levels which can also be very dangerous and may lead to asphyxiation!
How are the objects retrieved?
All foreign bodies in the throat must be retrieved in a surgical procedure with the child completely asleep. Using special instruments, the esophagus or the trachea are entered, and the foreign body is grasped and removed.
What can parents expect after retrieval?
Given that the patient arrives to the emergency room in a timely manner, the patient will usually go home on the same day once the foreign body is removed. In some cases, and depending on the foreign body present in the airway or esophagus, the patient will need to be admitted to the hospital for further management and monitoring. This is most likely to happen when the foreign body is a button battery.
Dr. Jana Ghulmiyyah completed her residency in Otolaryngology Head and Neck Surgery at the American University of Beirut. She then went on to pursue a fellowship in Pediatric Otolaryngology at Children’s Mercy in Kansas City. As of October 2022, Dr. Ghulmiyyah has joined Maimonides Medical Center and is currently treating all ear, nose and throat problems in children younger than 21 years of age. Dr. Ghulmiyyah treats children with recurrent ear infections, enlarged tonsils and adenoids, children with sleep disordered breathing and sleep apnea, pediatric neck masses and children with airway anomalies.