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32 THE NOSE AND PARANASAL SINUSES
bloodstained. The object may swell with the absorption of moisture from the
mucus, but pain is seldom complained of. A unilateral nasal discharge in
childhood is nearly always due to a foreign body, and if the discharge has an
unpleasant smell this is pathognomonic.
In the early stage the object is situated just within the nostril and is easily
seen. In time it moves further into the nasal cavity—possibly due to the child's
habit of sniffing or possibly because it is.pushed further in—and it becomes
Fig. 21. Opaque foreign body (press stud) in left nasal cavity.
encased with mucus, or mucopus if the object is organic in origin. In this
event it may not be seen because of the mucopus or the inflammatory swelling
of the mucous membrane.
Removal of the foreign body may be easy if it lies in the nostril. It may be
flicked out with a probe, or by getting the child to smell pepper and on closing
the opposite nostril it may be sneezed out. When the object reaches the nasal
cavity and becomes covered with secretions it becomes slippery and not easy to
grasp. A child may sit through one attempt at removal but if this fails, and
especially if the attempt produces bleeding, it is not likely to endure a second.
Accordingly it is wiser to give the child an anaesthetic for the removal if one
attempt has been made or if the object is situated far back at the initial
inspection. The anaesthetic need only be a short one for removal is usually
easily accomplished either with cupped forceps or with a metal probe, the
distal 5 mm of which have been bent to a right angle. The probe is passed,
point downwards, above the object which is pressed to the floor of the nose
and then raked out. The probe may fail with such a narrow object as a shirt
button because it slips, or with foam rubber which has become adherent to the
mucosa. In these cases the cup-shaped forceps is preferable. Very occasionally
the foreign body may be of such an irregular shape that it cannot be brought
out through the anterior naris, and it may have to be pushed gently into the