Nasal Foreign Body & Epistaxis

Question 1

Presentation/complaints of Nasal Foreign Body

Answer 1

• Sneezing
• discomfort/pain
• unilateral discharge
• foul odor
• epistaxis
• mouth breathing
• Swelling

Question 2

What is the work up/Exam of the nasal foreign body?

Answer 2

• Thorough exam w good light source

- may have to do imaging (CT/Xray) if complicated.

Question 3

What is the Treatment for Nasal Foreign Body?

Answer 3

FB Removal… obviously. Can be done using the following methods

- Mouth to Mouth
- Katz Extractor
- Ear Curette
- Suction
- ENT Consult
- May require sedation
- May require nothing else, but may need to consider Abx/ENT f/u

Question 4

What are the complications of Nasal Foreign body?

Answer 4

• could lead to an infection (localized vs toxic shock)
• bleeding
• Necrosis (prolonged pressure) with secondary syechia (scar band) that results in obstruction.

Question 5

What is the Etiology of Epistaxis?

Answer 5

• trauma
• dry air/nasal O2
• foreign body
• structural abnormality (mass/telangiectasia)
• drugs (thinners/steroid nasal spray/ street drugs)
• allergic rhinitis
• hypertension (not a direct cause but can be a contributing factor)

Question 6

Where (anatomically) does epistaxis normally occur?

Answer 6

Anterior= >90% in most kiesselbach plexus

Question 7

Describe the exam for epistaxis

Answer 7

• patient–> sitting up in gown
• use a good light source
• Eval pharynx for significant bleeding
• clear nose/ use suction

Question 8

What is the Tx for Epistaxis

Answer 8

-First line–> pressure 15 minutes

other options: remember push back NOT up.

- vasolene gauze
- merocele
- silver nitrate
- rapid rhino- most commonly used 
- Epistat    - Foley (posterior bleed)