When “Up Your Nose” Should Be Taken Literally
Published: Tuesday, 25 October 2022 10:53
Dr. Clare Dean, Otorhinolaryngology
“In the 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 stuffed up children’s noses, there are several fairly common objects that can be removed relatively easily, and some that can pose a serious risk.
I classify such objects into three groups: organic, inorganic, and button cells. While the latter, named for their size and button-like shape, are inorganic, they can of course pose a real health hazard to a child. Basically these batteries can create a negative ion field around them, a very alkaline environment. Not only can it be painful (imagine getting lye in your nose, ear, or mouth), but it can also cause an actual burning inside the nose, resulting in tissue necrosis (death) and potentially burning a hole in the nose. partition.
For those reasons, such a case is a medical emergency. And it’s a time-sensitive situation, as significant damage can occur in a couple of hours.
A parent can try to pull the coin cell battery out with a strong magnet, which can suck it right out of the nasal passage. (When I was a resident, I had a magnet attached to my ID card for exactly those circumstances.)
If someone has a button cell stuck in their nose during the day, I recommend immediately calling an ENT doctor’s office, who will free up their hours to remove the item. After hours, you should go immediately to an emergency department. To avoid a long wait, be sure to tell the admitting staff member that your child has a button battery in his nose and that he needs to see a doctor right away.
Fortunately, my other two categories are not usually as traumatic or time sensitive. Although an object stuck in the nasal cavity can theoretically be suctioned into the trachea, aspiration is a rare occurrence. I compare having organic or inorganic objects stranded nasally to getting a scrape on the knee, unpleasant perhaps, but quick to heal.
Organic objects tend to have more complications because they are more likely to cause infection and changes in 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 mucous membrane can make it soft and more difficult to remove over time. I generally recommend removing organic objects within a few hours of the incident.
Inorganic items like coins, Legos, crayons, and beads can be addressed in a day or two. Damage to your tissues (excluding button cells) is limited to scratches or local inflammation and is less likely to cause infection in the long term, or even short term.
To remove such objects, we can use a number of tools, including a specialized type of tweezers and even small hooks; when used at the right angle, we can go right into a bead’s hole and pull it out, or go behind the object and effectively pull it out. Due to the need for these specialized tools, a visit to the otolaryngologist is preferred over a visit to the emergency room. However, if the child is responsive and can follow directions, the parent can ask the child to breathe in through the mouth and then out through the nose; this approach often forces the object out.
I would set the timeline for seeking help as:
• Coin cell battery: drop everything and go to the emergency room right away
• Organic Substances: Finish what you’re doing and be gone in a few hours.
• Inorganic objects (excluding coin cell battery) – you can potentially wait longer to get to an ENT office
Even though I’m a doctor, the worst thing to deal with is a bug. They are actually very common, but never something you want to see!
Dr. Clare Dean He is an otolaryngologist at White Plains Hospital Medical & Wellness in Armonk and at Scarsdale Medical Group in Harrison. For an appointment, call 914-849-3755.