|Year : 2019 | Volume
| Issue : 2 | Page : 100-103
Nasal foreign bodies among pediatric population in Zaria-Nigeria
Iliyasu Yunusa Shuaibu1, MA Usman1, D Chitumu2, A Ajiya2, NA Shofoluwe1
1 Department of Surgery, Division of Otorhinolaryngology, Ahmadu Bello University, Zaria, Nigeria
2 Department of Otorhinolaryngology, Bayero University, Kano, Nigeria
|Date of Submission||22-Aug-2019|
|Date of Decision||18-Oct-2019|
|Date of Acceptance||08-Nov-2019|
|Date of Web Publication||13-Dec-2019|
Iliyasu Yunusa Shuaibu
Department of Surgery, Division of Otorhinolaryngology, Ahmadu Bello University, Zaria
Source of Support: None, Conflict of Interest: None
Background: Nasal foreign body (FB) is a common reason for presentation to the emergency units and the Otorhinolaryngologist. Objectives: To report the pattern and management of pediatric nasal FBs in Ahmadu Bello University Teaching Hospital Zaria. Methodology: The records of patients managed for nasal FBs over a 5-year period between January 2013 and December 2017 were reviewed. Data obtained for this study included demographic characteristics such as age, sex, type of FBs, laterality or bilaterality, method of removal, and presence or absence of complications. The data were analyzed using Statistical Product and Service Solution version 23.0. Results: There were 48 (55.8%) males and 38 (44.2%) females with male-to-female ratio of 1.3:1. The mean age was 3 years with standard deviation of ±1. In total, 76 (88.4%) of the patients were between 1 and 4 years of age. Beads (30, 34.9%) and foam (15, 17.4%) were the most common FBs inserted into the nose in this study by the patients. Among the different nasal FB, there were 57 (66.3%) inorganic FBs and 29 (33.7%) organic FBs. Right nasal cavity (43, 50%) was the most common site of lodgment in this series followed by the left nasal cavity (43, 48,8%). Nasal FB were removed in the clinic using instruments in 85 (98.8%) cases. Conclusion: Children between 2 and 4 years are more prone to nasal FB inhalation. There is the need for increased awareness among the parents who use beads for decoration or worship and indiscriminate disposal of button batteries.
Keywords: Children, foreign body, nose, Zaria
|How to cite this article:|
Shuaibu IY, Usman M A, Chitumu D, Ajiya A, Shofoluwe N A. Nasal foreign bodies among pediatric population in Zaria-Nigeria. J Med Trop 2019;21:100-3
| Introduction|| |
Nasal foreign body (FB) is any object or substance inappropriately inserted into the nose. It is a common reason for presentation to both the emergency units and the Otorhinolaryngologist. It has been reported to be more common among children between 2 and 4 years of age. Nasal FBs can be broadly classified into organic (such as papers, sponge, nuts, and beans) and inorganic (such as beads, pieces of toys, foams, batteries, and magnets).  FBs may be inserted by the child, siblings, or other children in school or at home or part of child abuse. Curiosity and interest in exploring the natural orifices may be the reason for inserting these FBs in the nose. It has also been suggested that children with hyperactivity/attention deficit and impaired behavioral development due to neurological deficit may be at increased risk of having nasal FBs.  Unilateral nasal discharge is the most common symptoms of FB in the nose, usually occurring approximately after 4 days, but objects like button battery can give immediate symptoms.  The nature of the FB may also determine the type of symptoms, for example irregular shaped inorganic FB may present with epistaxis and pain. Most cases of nasal FBs can be removed in the clinic by restraining the child and using a bent Jobson Horne probe  by inserting it above the FB and dragged along the floor of the nose or by grasping it with forceps in the case of foam. However, in non-cooperating child, removal under general anesthesia (and endotracheal intubation to protect the airway) may be indicated. Several other methods such as using Forgarty catheter  to remove nasal FB have been well established. It involves passing the catheter above the FB and inflating the balloon with water (1–2 mls) and then pulling it backward. Another method is the use of positive pressure to expel the nasal FB, the so-called mother’s kiss has been very popular with encouraging results. It involves mouth-to-mouth gentle blowing of air into the child’s mouth and at the same time using one finger to occlude the unaffected nostril to create positive pressure, which can expel the FB. This procedure may not be successful in hollow FB. 
There is limited information in the literature on nasal FBs from the North Western Nigeria. Therefore, there is need to report the pattern and peculiarities of FBs in the nose in our environment. The aim of this study is to report the pattern and management of pediatric nasal FBs in Ahmadu Bello University Teaching Hospital, Zaria.
| Methodology|| |
This was a retrospective descriptive study of patients who were presented with FBs in the nose to the accidents and emergency unit and ear, nose, and throat clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Ethical approval was obtained from the Ethics Review Committee of Ahmadu Bello University Teaching Hospital, Zaria. The record of patients managed for nasal FBs over a 5-year period between January 2013 and December 2017 was reviewed. All the patients included had FB removal. Data obtained included demographic characteristics such as age, sex, type of FBs, laterality or bilaterality, method of removal, and presence or absence of complications. Excluded from the study were patients whose case records were either not found or did not have complete information. The data were entered into the spreadsheet and analyzed using the Statistical Product and Service Solution version 23.0 software (SPSS Inc., Chicago, Illinois, USA). Quantitative data were summarized as frequencies and percentages and presented as tables.
| Results|| |
From the 123 patients who were presented with nasal FBs within the period under review, only 86 fulfilled the inclusion criteria. The patient’s ages ranged from 1 to 8 years. The mean age was 3 years with standard deviation of ±1. The median age was 3 years. There were 48 (55.8%) males and 38 (44.2%) females with male-to-female ratio of 1.3:1. In total, 76 (88.4%) of the patients were between 1 and 4 years of age [Table 1].
|Table 1: Age sex distribution, types, and side of lodgment of foreign bodies among the study population (n = 86)|
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Beads (30, 34.9%) and foam (15, 17.4%) were the most common FBs inserted into the nose in this study by the patients [Table 1]. Among the different nasal FBs, there were 57 (66.3%) inorganic FBs and 29 (33.7%) organic FBs. Right nasal cavity (43, 50%) was the most common site of lodgement in this series followed by the left nasal cavity (43, 48.8%). Only one (1.2%) had bilateral FB [Table 1].
Nasal FBs were removed in the clinic using instruments in 85 patients (98.8%). Only one (1.2%) patient with button battery in the nose had removal under general anesthesia. We recorded a complication suggestive of pulmonary edema in one patient with button battery in the nose. Fifteen of our patients (17.4%) had mild epistaxis following removal of the nasal FBs.
| Discussion|| |
Children between 2 and 4 years are more susceptible to nasal FBs in this study. Majority of our patients were boys. Inorganic FBs mainly beads and foams were the most common and were lodged in the right nasal cavity. Most of the FBs were removed in the clinic using instruments like Jobson Horne probe, bayonet forceps, crocodile forceps depending on the nature of the FBs
This study showed that children between 2 and 4 years are more susceptible to having nasal FBs. This was also the findings of other similar studies., We observed that majority of our patients were male. This finding is corroborated by the report of Cetinkaya et al. and Yaroko et al. where they also found male preponderance in their studies. However, contrary findings of female preponderance were reported by Regonnea et al. and Pagella et al. The higher number of male patients in our study may be due to the hyperactive nature of boys compared to girls. 
Beads were the most common nasal FBs followed by foam in this series. In a similar study by Abou-Elfadl et al. and Cetinkaya et al., beads constituted 53.2% and 52% of the nasal FBs in their studies respectively. In contrast to this, Yaroko et al. and Figureido et al. found seeds and sponge respectively as the most common nasal FBs in their series. However, in northwestern Nigeria, beads are widely used for decorative purposes on the hair and clothing. It is also used during worship as prayer beads. Therefore, children can easily get access to it and can insert it into their nasal cavities or those of their playmates.
Literature review showed that inorganic FB constitutes 70–92% of all nasal FBs. , Sixty-three percent of FBs in our series were inorganic mainly beads, foams, rubbers, and glass and this was also observed in other studies. , However, Figureido et al. and Afolabi et al. reported organic FBs to be more common than inorganic. Inorganic FBs may be asymptomatic and if unrecognized by the parents may remain there for considerable period of time and become coated with calcium, magnesium phosphate, and carbonate to form rhinolith, which may be discovered incidentally or when it increased in size to cause symptoms. On the other hand, organic nasal FBs may produce symptoms early due to its tendency to swell and irritate the nasal mucosa. In our series, FB was discovered incidentally in four patients who were presented with unilateral foul-smelling nasal discharge and denied history of FB insertion into the nose. This is consistent with the fact that FB should always be considered in any child with unilateral foul-smelling nasal discharge. FBs can be inserted in either right or left nasal cavity. However, cases of bilateral nasal FB are not uncommon. Regonnea et al., Yaroko et al., and Pagella et al. all reported the right nasal cavity as the most common. Our finding is in line with these reports where majority of FBs in our series were found in the right nasal cavity with only one patient having bilateral. Some authors suggested that this may be due to right predominant handedness.
Several methods for removing nasal FBs, both invasive and noninvasive have been described in the literature. In our study, majority of the FBs were removed in the clinic using instruments like Jobson Horne probe, bayonet forceps, crocodile forceps depending on the nature of the FBs. The child is usually restrained by the parents or other health personnel before removal. Among the two patients who were presented with button battery in the nose, one was removed under general anesthesia due to nasal mucosal edema and lack of cooperation. Following general anesthesia with endotracheal intubation and throat parking, the nasal cavity was suctioned and the FB was visualized using 0-degree rigid endoscope. There was also hyperemia of the surrounding structures. Boyle Davis mouth gag was then placed. The FB was pushed into the nasopharynx and subsequently retrieved trans-orally. Complication from button battery is very common and may occur rapidly. In one series, as high as 54% complication was reported. Leakage of the alkaline content from the button battery may occur and can spill into surrounding structures with attendant tissue damage. In our series, we recorded a complication suggestive of pulmonary edema in one patient with button battery. Brownish fluid was suctioned from the endotracheal tube which was similar to that suctioned from the nose during battery removal. However, the patient was managed conservatively and did very well. Apart from mild bleeding from the nose, we did not encounter any other complication during the course of removal of nasal FB in the clinic.
| Conclusion|| |
Children between 2 and 4 years are more susceptible to having nasal FBs. Inorganic FBs like beads and foams were the most common. Most of the nasal FB can be safely removed in the clinic using instruments. The case of button battery FBs should be taken very seriously as it may be associated with potentially fatal complications. There is the need for increased awareness among the parents who use beads for decoration or worship and indiscriminate disposal of button batteries. This will help in reducing the incidence of nasal FBs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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