“Up your nose with a rubber hose” became something of a catchphrase in the 1970s, thanks to its recurring use as an insult on the sitcom Welcome Back, Kotter. While we don’t see rubber hoses stuck up children’s noses, there are several fairly common objects that can be removed relatively easily – and some that can represent a serious risk.
I categorize such objects into three groups: organic, inorganic, and button batteries. While the last – so named for their button-like size and shape – are of course inorganic, they can pose a real danger to a child’s health. Such batteries can essentially create a negative ionic field around them, a very alkaline environment. Not only can it be painful – imagine having bleach in your nose, ear or mouth – it can also cause actual burning inside the nose, resulting in tissue necrosis (death) and potentially burning a hole in one’s septum.
For those reasons, such a case is a medical emergency. And it is a time-sensitive situation, as significant damage can occur within a couple of hours.
A parent can try to dislodge the button battery with a strong magnet, which may suck it right out of the nasal passage. (When I was a resident, I had a magnet connected to my I.D. badge for exactly such circumstances.)
If someone has a button battery stuck in their nose during the daytime, I recommend promptly calling an ENT’s office, who will clear their schedule to remove the object. After hours, you should go immediately to an emergency department. To avoid a long waiting time, make sure you tell the admitting staff member that your child has a button battery in his nose and that you need to see a doctor right away.
Happily, my other two categories are usually not as traumatic or time sensitive. While an object stuck in the nasal cavity can theoretically be sucked down into the windpipe, aspiration is an uncommon occurrence. I compare having either organic or inorganic objects nasally stranded to suffering a knee scrape – unpleasant, perhaps, but quickly healed.
Organic objects tend to have more complications because they are more likely to cause infection and change within the nasal environment. If a child has pushed a piece of food – a peanut is a popular choice – into their nasal cavity, its interaction with the mucus membrane can turn it mushy and harder to remove over time. I usually recommend getting organic objects removed within hours of the incident.
Inorganic items like coins, Legos, crayons and beads can be addressed within a day or two. Their tissue damage (excluding button batteries) is limited to scrapes or local swelling and is less likely to cause long-term, or even short-term, infection.
To remove such objects, we can use a number of tools, including a specialized kind of tweezers and even little hooks; when used at the correct angle, we can get right into the hole of a bead and pull it out, or go behind the object and effectively push it out. Because of the need for these specialized tools, an ENT visit is preferred over an ER visit. However, if the child is responsive and able to follow directions, the parent can ask them to inhale through their mouth and then exhale through their nose; this approach frequently forces the object out.
I’d lay out the timeline for seeking help as:
- Button battery – drop everything and go to the ER immediately
- Organic substances – finish what you’re doing and go within a few hours
- Inorganic objects (excluding the button battery) – you can potentially wait longer to make it to an ENT office
Even though I’m a physician, the worst thing to deal with is a bug. They are actually very common, but never something you want to see!