FOREIGN BODIES from three to five years of age like to shove small objects into the nose (pebbles, glass beads, peas, beans, cherry seeds, paper balls, etc.). More rarely, foreign bodies get into the nose through the posterior nares by choking or coughing (pieces of bone, fruit seeds, etc.). Occasionally, so-called rhinoliths develop on the spot, i.e., concretions of carbonate and phosphate of lime which may adhere to a small foreign body or perhaps merely to a blood clot. Only very seldom in our region are found the larvte of flies (Peiper) which may- produce serious cerebral disturbances.
first, there exists only a simple obstruction of the affected half of the nose, which often does not inconvenience the child, but which may give a nasal intonation to the voice. Since children often seek to conceal the fact from fear of punishment or at first may not even notice it, the foreign body may remain undiscovered for days, and smooth, round, impervious objects, even for years. Angular objects, especially those which are pervious and capable of swelling (peas, beans, though usually only after a short period), cause a local inflanimation which may lead to an offensive, bloody discharge, ulceration, and forma tion of granulations. It may also lead to purulent otitis, general infec tion, and cerebral manifestations.
The diagnosis is easy, if the child is brought by the alarmed parents to the physician, immediately after the occurrence. The foreign body usually rests far forwards in the nose, usually in the middle nasal pas sage or between the inferior turbinated and the septum. From awk ward attempts at extraction it has often slipped further backwards.
Very often the physician sees the patient only- after 1-2 weeks, or even very much later, when more inflammatory reaction has set in. A one sided, purulent, offensire discharge in a child almost always points to a foreign body, as abscess of the accessory cavities is of rare occurrence. Careful cleansing, cocainization, and examination with the probe, is then often necessary for diagnosis.
The treatment of the foreign body is simple. Very- frequently, the physician can force it out by manual pressure on the v.ing of the nose. In older children, blowing the nose vigorously with closure of the free side, is at times sufficient to cause the expulsion of the object; but in younger children it is often necessary to use a Politzer air-douche to the free nasal side. If the foreign body is wedged in, it is worked out by means of a heavy probe which is bent at a right angle at its extremity for about 1 cm. It is passed from above to the rear of the foreign body, and drawn out with a vigorous jerk. Ultimately, for the reduction of tbe swelling, cocainization will be found very useful. Occasionally, a wire snare, or a tenaculum forceps, will grasp the object better than the bent probe. If the object is in the rear portion of the nose, whence it is often impossible to bring it forward, it is then pushed backwards while the velum palati is raised with one index finger, so that the foreign body cannot possibly drop into the larynx. In obstreperous children bromethyd narcosis is often required.