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An audit of paediatric nasal foreign bodies in Ilorin, Nigeria
Abstract
Background. Children with nasal foreign bodies are commonly seen in everyday practice. The aim of this study was to document the pattern of foreign bodies in the nose, their treatment and outcome.
Methods. This was a prospective audit of all children seen in the ear, nose and throat clinic, accident and emergency unit and emergency paediatric unit at the University of Ilorin Teaching Hospital, Nigeria, from August 2005 to July 2006.
Results. Of a total of 173 patients with ear, nose and throat foreign bodies seen during the study period, 71 patients had foreign bodies in the nose. The male/female ratio was 1.5:1 and the mean age was 2.5 years (range 1 - 15 years), under-5s comprising 72% of the patients. The most common foreign bodies were grains and seeds (35%). Presentation was within 24 hours in 45% of cases, between 1 and 5 days in 27%, and longer in the rest. Of the patients 51% had inserted the foreign body into the nose themselves, and in 39% of cases this had happened at school. In most cases (68%) the foreign body had been inserted into the right nostril. Most children had an offensive nasal discharge (45%) or were asymptomatic (27%). Parents were the first to make the diagnosis in 63% of cases, and in 32% of cases removal had been attempted before presentation. Most of the foreign bodies (89%) were mechanically extracted with a Jobson-Horne probe. In 61% of cases removal was done by a senior registrar. General anaesthesia was needed in a minority of cases. Minimal epistaxis after removal occurred in 50.7%, and only 1 patient had septal perforation.
Conclusion. Nasal foreign bodies are still a challenge among under-5s. Public health education is needed to make parents and caregivers aware that it is hazardous for a child to insert a foreign body into the nose. Consistent with published guidelines, the majority of cases can be managed safely with direct extraction in the office setting. With adequate training, primary health care practitioners can manage most cases successfully and will know when to refer complicated ones.
Methods. This was a prospective audit of all children seen in the ear, nose and throat clinic, accident and emergency unit and emergency paediatric unit at the University of Ilorin Teaching Hospital, Nigeria, from August 2005 to July 2006.
Results. Of a total of 173 patients with ear, nose and throat foreign bodies seen during the study period, 71 patients had foreign bodies in the nose. The male/female ratio was 1.5:1 and the mean age was 2.5 years (range 1 - 15 years), under-5s comprising 72% of the patients. The most common foreign bodies were grains and seeds (35%). Presentation was within 24 hours in 45% of cases, between 1 and 5 days in 27%, and longer in the rest. Of the patients 51% had inserted the foreign body into the nose themselves, and in 39% of cases this had happened at school. In most cases (68%) the foreign body had been inserted into the right nostril. Most children had an offensive nasal discharge (45%) or were asymptomatic (27%). Parents were the first to make the diagnosis in 63% of cases, and in 32% of cases removal had been attempted before presentation. Most of the foreign bodies (89%) were mechanically extracted with a Jobson-Horne probe. In 61% of cases removal was done by a senior registrar. General anaesthesia was needed in a minority of cases. Minimal epistaxis after removal occurred in 50.7%, and only 1 patient had septal perforation.
Conclusion. Nasal foreign bodies are still a challenge among under-5s. Public health education is needed to make parents and caregivers aware that it is hazardous for a child to insert a foreign body into the nose. Consistent with published guidelines, the majority of cases can be managed safely with direct extraction in the office setting. With adequate training, primary health care practitioners can manage most cases successfully and will know when to refer complicated ones.
