How did that get there? A population-based analysis of nasal foreign bodies

Characteristics and treatment of pediatric nasal foreign bodies with button batteries-A retrospective analysis of 176 cases

PURPOSE

Button battery nasal impactions pose serious risks due to complications and the need for prompt removal, yet research on interventions remains limited due to its rare occurrence. To delineate the clinical manifestations of nasal foreign bodies associated with button batteries and to explore treatment approaches focused on minimizing the reliance on general anesthesia and surgical interventions.

METHODS

This study focuses on 176 cases of children who received treatment for nasal cavity button battery impactions. It encompasses various factors including age, gender, battery location, impaction duration, methods of extraction, and associated complications.

RESULTS

The incidence of nasal button battery cases among nasal foreign body instances was 1.16%, with a majority being males (60.23%) aged 1-5 years (98.29%). Utilizing a specially designed nasal foreign body hook and following established treatment protocols enabled the successful outpatient management of the majority of cases. Only 12 cases (6.82%) necessitated removal under general anesthesia due to management challenges in an outpatient setting. Furthermore, our findings indicated no linear correlation between the duration of battery retention and the risk of nasal septal perforation, which was observed in 31 cases (17.61%).

CONCLUSION

Nasal foreign bodies caused by button batteries in children demand urgent attention due to their potentially grave outcomes. Our research is directed towards enhancing diagnostic and therapeutic strategies to bolster the success rates of outpatient removal, curtail the duration of foreign body retention, and diminish the reliance on general anesthesia.

The association of nasal foreign bodies with type 1 hypersensitivity in children

PURPOSE

This study aimed at investigating the type 1 hypersensitivity reaction frequency of children with nasal foreign body history.

METHODS

From the medical records, we collected data regarding demographics (age and gender), symptoms, history of allergic diseases, physical examination, laboratory and test results, radiographic findings, the presence of any need for a second intervention, and complications. By reference to the presence of nasal foreign body history, two groups were constituted: the nasal foreign body group and the control group. Type 1 hypersensitivity frequency of the nasal foreign body group was compared with the control group.

RESULTS

In the nasal foreign body group, 47 of 110 patients (42.7%) had a previous history of type 1 hypersensitivity reaction, while only 15 of 100 patients (15%) had a previous history of type 1 hypersensitivity reaction in the control group. The frequency of type 1 hypersensitivity reactions was significantly higher in patients with a history of nasal foreign body, compared to the patients without (p < 0.001, X² = 19.35).

CONCLUSION

Children with type 1 hypersensitivity reactions may be more likely to present with nasal foreign bodies. Physicians should pay more attention to the history of type 1 hypersensitivity reactions in children presenting with nasal foreign bodies.

I'm All Ears: A Population-Based Analysis of Consumer Product Foreign Bodies of the Ear

OBJECTIVES

The purpose of this study was to assess the nationwide incidence of ear foreign body (FB) presentations to the emergency department (ED) and analyze the most common FB consumer products encountered.

METHODS

The National Electronic Injury Surveillance System (NEISS) was evaluated for ED visits that included "ear foreign bodies" from 2010 through 2019. The most frequent foreign bodies were identified and organized by demographics.

RESULTS

A total of 20,545 ear FB cases were found, with an estimated 608,860 ED visits nationwide. Female patients (56%) were more likely to have jewelry and first aid equipment FBs. Males between the ages of 5 and 15 years were significantly (P < 0.05) more likely to have paper products, pens/pencils, and desk supplies in their ears.

CONCLUSION

Ear FBs represent a substantial proportion of healthcare expenditures. Although children are the most commonly affected individuals, all ages require further education and preventive measures.

Presentation and management of nasal foreign bodies in a Chinese metro area

Nasal foreign bodies in children are common complaints encountered by pediatric otolaryngologists. We investigated clinical features, diagnosis, and treatment of nasal foreign bodies in children in a Chinese metro area.Six hundred sixty eight children with nasal foreign bodies presented to Shenzhen Children's Hospital, diagnosed and treated by the authors were enrolled from January 2016 to October 2019, causes for medical consultation, age, sex, duration, types, locations, removal, and complications were recorded and analyzed.Nasal foreign bodies were common in children between 1 and 5 years of ages (96.8%). The right nasal cavity (61.4%) was the most common site for foreign body insertion (61.4%). Most of the children (89.4%) presented for a complaint of nasal discomfort or foreign body insertion themselves, or for foreign body impaction discovered by the caregivers. Most of the foreign bodies (85.0%) were discovered within 1 day. The most nasal foreign bodies were the whole toys and toy parts (34.1%). The majority of nasal foreign bodies (99.1%) located in the antero-inferior portion of the nasal cavities and could be removed with simple instruments. The occurrence of complications in nasal foreign bodies (10.2%) was not common.The present study objectively exhibited clinical features, diagnosis, and treatment of nasal foreign bodies in a Chinese metro area.

Management of an Unusual Intranasal Foreign Body Abutting the Cribriform Plate: A Case Report and Review of Literature

A 35-year-old man with history of schizophrenia presented 3 weeks after placing a screw in his right nostril. Initial imaging showed a screw in the right ethmoid sinus with the tip penetrating the right cribriform plate. On exam, the patient was hemodynamically stable with purulent drainage in the right nasal cavity but no visible foreign body. While most nasal foreign bodies occur in children and are generally removed at the bedside, intranasal foreign bodies in adults tend to require further assessment. The foreign body in this case was concerning for skull base involvement and the patient was brought to the operating room (OR) with neurosurgery for endoscopic sinus surgery (ESS) and removal of foreign body. The screw was removed and the patient recovered with no signs of cerebrospinal fluid (CSF) leak postoperatively. Any concern for skull base or intracranial involvement should call for a full evaluation of the mechanism of injury and intervention in a controlled environment.

Will children ever learn? Removal of nasal and aural foreign bodies: a study of hospital episode statistics

Introduction Foreign body removal is a common reason for children to attend the emergency department. Generally, aural and nasal foreign bodies are not associated with immediate morbidity unless they are button batteries. There can be consequences of migration and removal. Methods Hospital Episode Statistics for 2010-2016 were used to calculate the number of nasal and aural foreign bodies that have been removed in hospital. Data for adults and children have been compared. Results 8752 nasal and 17,325 aural foreign bodies have been removed from adults and children over the course of 6 years. Children were responsible for 95% of the 8353 nasal and 85% of the 14,875 aural foreign body presentations. Children aged 1-4 years are most at risk of injury. Conclusion Children are more likely to present to hospital than adults with a foreign body in the ear or nose. Aural bodies were more likely to need removal in hospital for both populations. Authors believe that these require identification and removal by an ear, nose and throat specialist to prevent morbidity. The overall number of procedures performed annually in children has not reduced over the study period; an average of 1218 nasal and 2479 aural foreign body removals are performed each year with an annual cost of £2,880,148 to NHS England.

Management of Epistaxis in Children and Adolescents: Avoiding a Chaotic Approach

This article provides an organized foundation that facilitates the management of acute epistaxis and an understanding of features that merit further diagnostic workup. Prompt management, including measures such as holding pressure and using nasal packing, takes precedence over comprehensive diagnostic workup. Severe, recurrent, and posteriorly based bleeds should prompt consideration of alternate interventions and expert consultation.

The art of removing nasal foreign bodies

Objective

The removal of nasal foreign bodies (NFBs) can be a difficult task for the inexperienced physician, and the more unsuccessful attempts are made, the more difficult the extraction becomes. We have formulated this simple “four-step” approach to improve success, especially on the first try.

Methods

A retrospective review of cases requiring NFB removal, seen by one registrar from 2012 to 2016 at Frankston Hospital, was performed.

Results

From 2012 to 2016, 93 patients were referred, of whom 65 were confirmed to have NFBs. In all, 20 patients were first seen by the registrar and had the NFB removed successfully. Another 28 patients were referred to the registrar only after one failed attempt by another medical personnel, and the remaining 17 patients were referred after two failed attempts. All patients had the NFB removed locally in the emergency department using the “four-step” approach, except four patients who had the NFB removed under general anesthesia in the operating theater. Three of the latter had two failed attempts and had refused further attempts, and the fourth patient had developed epistaxis after a failed removal by his general practitioner.

Conclusion

When performed correctly, the “four-step” approach will result in the successful removal of NFBs. Ideally, the removal of NFBs should only be performed by an experienced medical personnel, and any failed first attempt removals must be subsequently managed only by an experienced medical personnel.

Traumatic Facial Injuries Among Elderly Nursing Home Residents: Never Event or Frequent Occurrence?

Importance

As the nursing home population continues to increase, an understanding of preventable injuries becomes exceedingly important. Although other fall-related injuries have been characterized, little attention has been dedicated to facial trauma.

Objectives

To estimate the incidence of facial trauma among nursing home residents and detail mechanisms of injury, injury characteristics, and patient demographic data.

Design, Setting, and Participants

The National Electronic Injury Surveillance System was used to calculate a weighted national incidence of facial trauma among individuals older than 60 years from a nationally representative collection of emergency departments from January 1, 2011, through December 31, 2015. Entries were screened for nursing home residents, and diagnosis, anatomical site, demographic data, and mechanism of injury were analyzed.

Results

There were 109 795 nursing home residents (median age, 84.1 years; interquartile range, 79-89 years; 71 466 women [65.1%]) who required emergency department care for facial trauma. Women sustained a greater proportion of injuries with increasing age. The most common injuries were lacerations (48 679 [44.3%]), other soft-tissue injuries (45 911 [41.8%]; avulsions, contusions, and hematomas), and fractures (13 814 [12.6%]). Nasal (9331 [67.5%]) and orbital (1144 [8.3%]) fractures were the most common sites. The most common injury causes were direct contact with structural housing elements or fixed items (62 604 [57.0%]) and transfer to and from bed (24 870 [22.6%]).

Conclusions and Relevance

Despite falls being considered a Centers for Medicare & Medicaid Services preventable never event in hospitals, our analysis in the nursing home setting found more than 100 000 facial injuries during 5 years, suggesting these underappreciated injuries contribute substantially to health care expenditures. Although structural elements facilitated the greatest number of falls, transfer to and from bed remains a significant mechanism, suggesting an area for intervention.

A population based analysis of the implementation of pediatric facemasks in girls youth lacrosse

OBJECTIVE

To determine the incidence, relative risk reduction, odds ratio and absolute risk reduction of head and ear injuries associated with the implementation of pediatric facial eye guards in lacrosse events.

STUDY DESIGN

Cross Sectional Review of a National Database.

STUDY LOCATION

National Emergency Injury Survelliance System.

METHODS

Our group retrospectively reviewed a nationwide sampling estimate of 809 patients who presented to emergency rooms with head and ear injuries during lacrosse events. The database was queried for lacerations, fractures, hemorrhages, abrasions and punctures associated with the face and ear. Incidence, relative risk, odds ratio and absolute risk reductions were calculated both five years before and five years after the introduction of the facial mask guard in 2006 to determine benefit.

RESULTS

Of the 809 women's lacrosse injuries, 199 were localized to the facial region and 56 to the ear. After the implementation of the facial mask mandate, there was a significant decrease in the total incidence and relative risk of facial lacerations (P = 0.01, RR = 0.08 vs 0.01) and facial abrasions (P = 0.02, RR = 0.28 vs 0.12) respectively. Furthermore, there was a significant decrease in the odds of obtaining a facial laceration (OR: 0.16 95% CI:0.07-0.37), facial fractures (OR: 0.01, 95% CI:0.03-0.35) and abrasion (OR: 0.11, 95% CI:0.08-0.18) with facemask use. Unfortunately, there was no difference in total incidence, relative risk or odds of obtaining ear injury.

CONCLUSION

It appears that the implementation of the mandate for female athletes to utilize the facemask starting in 2006 has provided a reduction in specific facial injuries. Further discussion should be continued in order to reduce further risk to the remaining head and neck region including the ears and neck with additional protective equipment.

A chilling reminder: Pediatric facial trauma from recreational winter activities

BACKGROUND

Winter activities offer children and adolescents an outdoor recreational opportunity during the coldest months. Our objectives were to estimate the national incidence of facial injury associated with recreational winter activities. Furthermore, we analyze demographic trends and clinical characteristics of patients presenting to emergency departments (EDs).

METHODS

The National Electronic Injury Surveillance System (NEISS), a population-based resource, was evaluated for ED visits from 2010 to 2014 for children injured from "active" winter -undertakings (snowboarding, skiing, ice skating) and sledding/tubing. Entry narratives were evaluated for demographics, diagnoses, and other clinical factors.

RESULTS

841 entries amounting to an estimated 27,618 patients were evaluated. The most common injuries were lacerations (69.4%), contusions/abrasions (19.5%), and fractures (5.5%), with the most common fracture sites being the nose (60.9%), orbit (15.2%), and mandible (10.9%). Median age was 9 years (IQR 5-12), and 65.8% were male. A greater proportion of adolescents sustained fractures than younger children (8.1% vs. 4.0%). The majority of fractures were to the nose.

CONCLUSION

With nearly 30,000 ED visits over five years, participation in winter sports can be perilous. Adolescents harbor a greater risk of sustaining serious injuries than younger children, and patients injured sledding/tubing had a greater fracture risk compared to those participating in more "active" winter activities. As upper/mid-face fractures occurred in only 1.4%, these findings reinforce a very limited role for CT. These findings suggest a need for greater use of facial protection and closer supervision of older children participating in these activities.

Forgetful but not forgotten: Bathroom-related craniofacial trauma among the elderly

OBJECTIVES/HYPOTHESIS

As our population ages, injuries attributable to falls continue to increase, impacting healthcare delivery. Evaluation of craniofacial trauma with focus on elderly patients remains an underappreciated concern. Our objectives were to evaluate injury trends associated with elderly bathroom falls, as this information may be useful for counseling and preventive purposes.

STUDY DESIGN

Database review.

METHODS

The National Electronic Injury Surveillance System was evaluated for craniofacial trauma among patients 60 years and older presenting to the emergency department (ED) (2010-2014). Injury descriptions were reviewed for mechanism of injury, patient demographics, and other injury characteristics.

RESULTS

In total, 7.2% of the estimated 3.4 million ED visits for elderly craniofacial trauma were bathroom related. Females comprised the majority (60.9%) of patients, and a plurality of patients were in their 80s. A greater proportion of facial injuries resulted from syncope (16.6% vs. 10.9% compared to head injuries). Toilets facilitated a greater proportion of facial insults and were more likely to require admission; the most common mechanism was "falling off." Showers contributed a majority of head injuries and had a lower median age than toilet injuries. Fractures comprised 12.6% of facial injuries; of craniofacial fractures, common sites included the nose (54%), mandible (6%), and orbit (6%). Admitted patients were significantly older than those who were released.

CONCLUSIONS

Bathroom falls result in a significant proportion of elderly traumatic injury. The trends we present offer the opportunity for targeted preventative measures to decrease the occurrence of these events. Additionally, this information may adjunct a detailed history and physical to ensure appropriate patient management.

LEVEL OF EVIDENCE

4 Laryngoscope, 127:820-827, 2017.

Adding Injury to Insult: A National Analysis of Combat Sport-Related Facial Injury

OBJECTIVES/HYPOTHESIS

To estimate the incidence of patients presenting to emergency departments (EDs) for facial trauma sustained from participation in combat sports and evaluate injury patterns and patient demographics.

METHODS

The National Electronic Injury Surveillance System (NEISS) was evaluated for facial injuries from wrestling, boxing, and martial arts leading to ED visits from 2008 to 2013. Relevant entries were examined for injury mechanism, location, type, as well as other patient characteristics.

RESULTS

There were 1143 entries extrapolating to an estimated 42 395 ED visits from 2008 to 2013. Injury rates for boxing, marital arts, and wrestling were, respectively, 44, 56, and 120 injuries per 100 000 participants. Males comprised the majority (93.7%). A plurality of injuries involved lacerations (46.0%), followed by fractures (26.2%) and contusions/abrasions (19.3%). The proportion of fractures was highest among boxers (36.9%). Overall, the most common mechanisms of injury were punching, kicking, and head butting.

CONCLUSIONS

The significant number of ED visits resulted from combat sports facial trauma, reinforcing the importance of familiarity with injury patterns among practitioners managing facial trauma. As most injuries involve individuals younger than 19 despite guidelines suggesting children and adolescents avoid combat sports, these findings may be used for patient education and encouragement of the use of personal protective equipment. Furthermore, injury patterns reported in this analysis may serve as an adjunct for enhancing clinical history taking and physical examination.

The Vicious Cycle

Objectives

Although prevention of head injuries through helmet use is widespread, there has been a paucity of inquiry and publicity regarding the potential for facial injury stemming from cycling. Our objectives included estimating the incidence of emergency department (ED) visits for bicycle-related facial trauma among the pediatric population and detailing injury patterns.

Study Design and Setting

Analysis of a nationwide database.

Methods

The National Electronic Injury Surveillance System, offered by the Consumer Product Safety Commission, was accessed for ED visits related to bicycle-related facial trauma among individuals 21 years old and younger. These data were used to estimate national incidence and examine patient demographics and injury characteristics.

Results

From 2010 to 2014, there were 5420 entries extrapolating to an estimated 178,457 ED visits for pediatric bicycle-related facial trauma. Median age was 8 years, and 71.9% of patients were male. Lacerations (63.1%), abrasions/contusions (27%), and fractures (7%) were most common, with fractures dramatically increasing in prevalence with age. Nasal fractures were the most common fracture type. Injury patterns varied by age.

Conclusion

Bicycle-related facial trauma is prevalent among the pediatric population, with nearly 180,000 visits to EDs between 2010 and 2014. Soft tissue injuries predominated among all age groups, although fractures increased significantly with age. Knowledge of injury patterns described may be a useful adjunct assisting history, examination, and decision making regarding the use of medical imaging. There is a clear void in inquiry regarding the use of facial protection, reinforcing the need for further study into prevention and efforts to raise public awareness among youth.

Avulsed Nasoenteric Bridle System Magnet as an Intranasal Foreign Body

Nasoenteric tubes provide short-term nutrition support to patients unable to take an adequate oral diet. Bridling systems may be used to secure tubes to guard against displacement. We present the first case of an avulsed magnet from a bridling system to raise awareness of this potential complication. The primary methods of securing a nasogastric tube are reviewed, and comparative assessment of the 3 main systems is presented. Diagnosis and management of nasal foreign bodies relevant to this case are reviewed and prevention/safety considerations discussed.