An unusual cause of nasal obstruction: a hair clip in the nasopharynx.

A 3-year-old girl was brought to the accident and emergency unit after she had swallowed a plastic hair clip. She appeared to be well and exhibited no respiratory difficulty. Findings on the ENT examination were normal, and x-rays of the chest and abdomen detected no foreign body. Her parents were reassured, and she was discharged home.

Two years later, the girl was referred to the ENT outpatient unit by her general practitioner for evaluation of recurrent nasal discharge that was purulent at times. Again, the patient appeared to be fit and well, and her history offered no insight to the nature of the discharge. Examination of the nose revealed a narrowing of the airway but no evidence of infection in either nasal cavity. The tonsils were enlarged, and small jugulodigastric lymph nodes were palpable. The patient was scheduled to undergo an adenoidectomy. During an examination under anesthesia, however, the surgeon discovered the hair clip and removed it (figure). No adenoidal mass was present. The patient did well postoperatively and was discharged the same day.

Foreign bodies are rarely encountered in the nasopharynx. (1) When they do occur, their presentation is varied. Unless they cause significant symptoms, discovery can occur well after insertion, as occurred in this case. Foreign bodies that become lodged in the adenoidal mass merit an adenoidectomy to facilitate removal. (1) The case of our patient was unusual in that her symptoms mimicked adenoidal hypertrophy. In hindsight, it is possible that she had initially swallowed the foreign body only to later cough it up into the nasopharynx.

Children who present with a history of a swallowed radiopaque foreign body should undergo an x-ray of the nasopharynx if initial chest and abdominal x-rays are negative. (2)

References

(1.) Saxena SK, Gopalakrishnan S, Ravi D. Unusual impacted foreign body in the nasopharynx. Indian Journal of Otolaryngology-Head and Neck Surgery 2002;54:151-2.

(2.) Parker AJ' Bingham BJ' Osborne JE The swallowed foreign body: Is it in the nasopharynx? Postgrad Med J 1988;64:201-3.

Sandeep Berry, MRCS; Huey Tay, FRCS 

From the Department of Otolaryngology--Head and Neck Surgery, Fairfield Hospital, Bury, U.K.