Removal of Foreign Bodies

What is considered a foreign body?

An object is considered a “foreign body” if the object is in a location in the body where it does not belong. Common foreign bodies found in children include coins, small toys, certain foods like peanuts, beans or even candy, and other small objects. Occasionally dislodged teeth or even bugs may be found. The most concerning object is a button type battery (like a camera, watch or hearing aid battery) as these can leak harmful substances and cause significant damage to the surrounding tissue. Children put all sorts of things into their ears nose and mouth. If you suspect your child has ingested a foreign object, consider this a medical emergency and seek immediate attention. If your child is choking, cannot breathe, or is turning blue, call 911 immediately.

How are foreign bodies discovered?
Often a parent or other caregiver will see the foreign body being placed by the child and will bring the patient to the emergency room or pediatrician. In other instances, the symptoms noted in the patient will point to the possibility of a foreign body. Through various tests or procedures this can be confirmed. Foreign bodies in the ear can lead to ear pain, hearing loss or drainage. Foreign bodies in the nose can lead to pain and foul smelling drainage from just one nostril. Foreign bodies stuck in the esophagus (swallowing tube) may cause excessive drooling, pain or the refusal to eat or drink. In most cases the type of object and how long it has been present will make a difference in the type of symptoms present.

Children between the ages of 7 months and 4 years are in the greatest danger of choking on small objects. This accounts for nearly 9% of all home accidental deaths. Foreign bodies stuck in the airway can cause noisy breathing, difficulty breathing or block the airway entirely leading to death if the object is not dislodged. For objects that get sucked down into the lungs, this can cause recurrent pneumonias or new onset wheezing. Any child with a strong clinical history for an airway foreign body should undergo a full airway endoscopy. Remember, many foreign bodies cannot be seen with X-rays.

Do foreign bodies always need to be removed?
Some foreign bodies which are swallowed and end up in the stomach usually pass out of the body with a bowel movement and do not cause significant problems. Keep in mind that any suspected foreign body should always be investigated. The focus of an ear nose and throat specialist is possible foreign bodies in the ear, nose, throat, or airway. If a foreign body is stuck in any of these areas, it is important to have it removed as there is no natural way for these objects to pass out of the body.

How are foreign bodies removed?
The technique used to remove a foreign body depends on the location and the object itself. Many objects stuck in the ear or nose can safely be removed in the office setting. This of course requires a cooperative child. Many times because of swelling or recent bleeding, it is safer to perform this procedure in the operating room under a brief general anesthetic. Children with suspected airway foreign bodies almost always require a trip to the operating room in order to perform a full airway evaluation. This is performed under general anesthesia using very special cameras and tools. The airway is first inspected and if any foreign bodies are seen, special instruments can be used to remove the object.