Describe nasal foreign bodies and rhinolith.

Foreign Bodies in the Nose

• A nasal foreign body is most often seen in children between 2 and 5 years, and in those with learning difficulty or psychiatric illness at any age.
• It lodges on the floor of the nose or between the septum and the inferior turbinate.
• The cardinal presentation IS unilateral foul-smelling purulent OR blood-stained discharge IN A child, and it is a foreign body until proved otherwise. The smell is the diagnostic feature, and is frequently what brings the family
• The history is frequently absent — the event was unwitnessed, or the child conceals it — so the absence of a history means nothing
• Other features — unilateral obstruction, sneezing, pain, epistaxis, and occasionally nothing at all
• Types — organic (seeds, pulses, paper, foam).
• The two emergencies, which must be recognised at once:
• 1. A button (disc) battery — which causes liquefactive necrosis from local alkali generated by the current, within hours, producing septal perforation, synechiae and saddle deformity. It must be removed immediately, as an emergency, and no delay for a list or for fasting is acceptable
• 2. Paired magnets, one in each nostril.
• Suspect a battery where the object is disc-shaped, and where there is rapid onset of pain, bleeding or a grey discoloration — if in doubt, treat as a battery
• Removal — the first attempt is the best attempt, and should be made under the best conditions available.
• Prepare properly — good light and suction, topical vasoconstrictor and anaesthetic, and proper immobilisation of the child, wrapped and held by a parent or assistant

Rhinolith

• A rhinolith is a calcified mass in the nasal cavity, formed by the deposition of calcium and magnesium salts (carbonates and phosphates) around a nidus over years
• The nidus may be endogenous (inspissated secretion, a blood clot, a bone fragment, a tooth) or exogenous — and most are an old, forgotten foreign body
• It presents in an adult with long-standing unilateral nasal obstruction and foul-smelling, often blood-stained discharge — the same picture as a foreign body, but over years rather than days, and in an adult who has forgotten the original event
• Examination shows a hard, gritty, greyish-brown irregular mass on the floor of the nose, which is hard on probing, surrounded by granulation tissue and pus
• Imaging — a radio-opaque mass on plain film or, better, CT, which shows the extent and any bony erosion and excludes other pathology