Printer Friendly
The Free Library
4,488,726 articles and books
Member login
User name  
Password 
 
Join us Forgot password?

Foreign body impaction: fifty years inside the nose.


Abstract

An incidental finding of a foreign body for·eign body (fôrn)
n.
An object or entity in the body that has been introduced from outside.
 in the nose is an infrequent event. When foreign bodies are discovered incidentally, they are usually detected during an investigation of chronic symptoms. We describe a case that is of interest because a nasal foreign body had remained clinically silent for more than 50 years.

Introduction

The presence of a foreign body in the nose is a relatively uncommon occurrence. A prolonged period of impaction
1. the condition of being impacted.
2. in obstetrics, the indentation of any fetal parts of one twin onto the surface of its co-twin, so that the simultaneous partial engagement of both twins is permitted.

dental impaction
 is even less common, but it is more likely when the foreign body is an inert object. (1-4) In this article, we describe a case of a nasal foreign body that had been impacted for more than 50 years before it became clinically evident.

Case report

A 60-year-old man presented to the ENT clinic with a sensation of mucus at the back of his throat and a foul smell emanating from his nose. These symptoms were of spontaneous onset and were not associated with any other condition or precipitating event. On direct questioning, the patient recalled that he had pushed a rubber stopper from a perfume bottle up his nose when he was a child more than 50 years earlier. He did not recall that this object had ever been retrieved.

A clinical examination, including a nasal inspection, revealed a minimal amount of catarrh catarrh /ca·tarrh/ (kah-tahr´) inflammation of a mucous membrane, particularly of the head and throat, with free discharge of mucus.catar´rhal

ca·tarrh (k-tär
, but no other evidence of a foreign body. The patient was then investigated for sinusitis, and computed tomography (CT) was ordered. CT detected an encrusted, calcified mass in the left nares nares /na·res/ (na´res) [L.] the nostrils; the external openings of the nasal cavity. (figure 1). The object was removed by nasal endoscopy with the patient under general anesthesia. The specimen measured 3 X 1 cm (figure 2). On microscopy, the foreign nature of the mass was confirmed; its features were consistent with a rubbery material. The patient made an uneventful recovery and was discharged home without follow-up.

[FIGURES 1-2 OMITTED]

Discussion

Foreign bodies in the upper aerodigestive tract can be a significant cause of morbidity and mortality, particularly in patients at the two extremes of age. (5) Unlike foreign bodies in other parts of the aerodigestive tract, which often produce noticeable symptoms, foreign bodies in the nose can go unrecognized for significant periods of time. In some cases, foreign bodies made of inert substances are fairly asymptomatic, (6) while in other cases they can cause chronic nasal symptoms. (2)

In our patient, the foreign body had not caused any symptoms for more than 5 decades. This can be attributed to the fact that it was made of a relatively inert material. The specific area of impaction may have partly accounted for the lack of symptoms. We had obtained CT in order to investigate the possibility that the patient had maxillary sinusitis. In fact, this was our working diagnosis in the absence of any physical findings on examination of the upper aerodigestive tract. CT, however, pointed us in the right direction. The patient's symptoms resolved following removal of the object.

It might be speculated that the appearance of symptoms after such a long period was attributable to the degradation of the rubber. Degradation products might have produced local mucosal irritation and triggered an inflammatory process and the production of excess mucus.

This case emphasizes the importance of history-taking and a broad differential diagnosis.

Acknowledgment

The authors thank Mr. Don McFerran, who was consultant in charge of this case, and Mr. John Benson, whose comments on the manuscript were most helpful.

References

(1.) Oysu C, Yilmaz HB, Sahin AA, Kulecki M. Marble impaction in the nasopharynx naso·pha·ryngeal (-f-rn following oral ingestion. Eur Arch Otorhinolaryngol 2003;260:522-3.

(2.) Ogut F, Bereketoglu M, Bilgen C, Totan S. A metal ring that had been lodged in a child's nasopharynx for 4 years. Ear Nose Throat J 2001;80:520-2.

(3.) Gendeh BS, Gibbs AG. An unusual foreign body presenting in the nasopharynx. J Laryngol Otol 1988;102:641-2.

(4.) Eghtedari F. Long lasting nasopharyngeal foreign body. Otolaryngol Head Neck Surg 2003;129:293-4.

(5.) McGill TJ, Ohlms L. Foreign bodies in the upper aerodigestive tract. In: Cummings CW, ed. Otolaryngology Head and Neck Surgery. 2nd ed. St. Louis: Mosby, 1993:2396-2400.

(6.) Becker W, Neumann HH, Pfaltz CR. Ear, Nose, and Throat Diseases. Stuttgart: Georg Thieme Verlag, 1994.

From the Department of Ear Nose and Throat Surgery, Colchester General Hospital, Colchester, Essex, U.K.

Reprint requests: Vassilis Pitsinis, MD, Apt. 8, 185-187 Hills Rd., Cambridge CB2 CB2 - Carnage Blender 2 (multiplayer strategy RPG) 2RN, UK. Phone: 44-1223-416-770; fax: 441223-416-561; e-mail: vpitsinis@aol.com
COPYRIGHT 2004 Medquest Communications, LLC
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2004, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

 Reader Opinion

Title:

Comment:



 

Article Details
Printer friendly Cite/link Email Feedback
Author:Patel, Alpa
Publication:Ear, Nose and Throat Journal
Geographic Code:1USA
Date:Aug 1, 2004
Words:735
Previous Article:Rhinoorbital mucormycosis secondary to Rhizopus oryzae: a case report and literature review.
Next Article:Laryngeal rhinosporidiosis: report of a rare case.
Topics:



Related Articles
A metal ring that had been lodged in a child's nasopharynx for 4 years.(Brief Article)
Foreign body in the esophagus. (Esophagoscopy Clinic).(Brief Article)
A rare case of a foreign body migration from the upper digestive tract to the subcutaneous neck. (Original Article).
Cervical esophageal foreign body. (Esophagoscopy Clinic).(Brief Article)
Comparison of direct vision and video imaging during bronchoscopy for pediatric airway foreign bodies. (Original Article).
Endoscopic view of a foreign body in the nasal cavity that initially resembled a polypoid mass. (Rhinoscopic Clinic).
Esophageal foreign body aspiration presenting as asthma in the pediatric patient.(Case Report)
Recurrent purulent rhinorrhea in an otherwise healthy woman.(Rhinoscopic Clinic)
The submucosal fish bone.(treatment of foreign body in submucosal plane)(Medical condition overview)
Perforating and migrating pharyngoesophageal foreign bodies: A series of 5 patients.

Terms of use | Copyright © 2008 Farlex, Inc. | Feedback | For webmasters | Submit articles