Foreign body impaction: fifty years inside the nose

Ear, Nose & Throat Journal, August, 2004 by Vassilis Pitsinis, Alpa Patel

Abstract

An incidental finding of a foreign body 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 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, 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 (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 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 2RN, UK. Phone: 44-1223-416-770; fax: 441223-416-561; e-mail: vpitsinis@aol.com