Nasal foreign bodies can be challenging from the standpoint of both diagnosis and management. Those caring for children or for patients in mental health facilities must consider nasal foreign bodies in the differential diagnosis of unilateral nasal obstruction, unilateral purulent rhinorrhea (Fig. 18-1), unilateral rhinosinusitis, and advanced facial cellulitis. Mobile foreign bodies can be easily pushed into the nasopharynx and aspirated into the airway, causing a potentially life-threatening situation. Prompt otolaryngologic consultation is helpful when a nasal foreign body is suspected, and all nasal foreign bodies require removal.

Nasal foreign bodies are customarily classified as animate or inanimate. Animate foreign bodies include larval infection, Aspergillus infection, rhinosporidiosis, and roundworm infection. Inanimate foreign bodies of the nose can be just about anything that fits. The mechanism of entry is usually at the hands of the patient or a playmate. Common nasal foreign bodies include beans, nuts, peas, fruit pits, chalk, crayons, pencil erasers, children’s modeling clay, jewelry, hardware (screws, nuts, bolts), and small pieces of plastic. Small alkaline batteries from a wristwatch or hearing aid can cause local tissue destruction and must be removed immediately. Vegetative nasal foreign bodies may cause local inflammatory reactions. Rhinoliths are calcified nasal masses that result from material left in the nose for prolonged periods of time.