Management of nasal foreign bodies at Kenyatta National Hospital

Abstract

A prospective crossectional descriptive study was carried out on 279 patients with nasal foreign bodies at the Ear, Nose and Throat clinic and casualty of Kenyatta National Hospital for seven months from 1SI August 2005 to 28th February 2006. The aim of the study was to determine the diagnostic pointers and therapeutic measures for nasal foreign bodies. It was noted that 75.3% of the patients were children less than three years of age whereas the age range was from 6 months to 21 years. The peak age was between 0 and 3 years. The sex distribution revealed that 52.3% of the patients were female and 47.7% were male. The highest number of patients presented to hospital within hours of insertion (80.3%) with history of FB insertion (52.7%). Most patients(7:.1 %) accepted inserting themselves whereas 11.8% were inserted by playmate and 6.8% was unknown. The NFBs were noticed by parents in 57% of the patients while selfreporting accounted for 27.2%. majority of NFBs were lodged in the right nostril(60.6%) and left nostril (36.9%) and not found were 2.1% and most of them had been attempted before presentation (69.2%) with such methods as tobacco sniffing,match sticks,pins and needles. The commonest FBs were the beads (34.4%),cereals (22.9%) and one case of rhinolith. They were mostly lodged in between the septum and

inferior turbinate (68.1 %) and septum and middle turbinate (25.8%). Removal was accomplished with hooks(51.5%) and forceps (44.4%) without anaesthesia (65.2%).Only 34.8% of patients had FBs retrieved under general anaesthesia for unco-operation (41.4% ),firm lodgement (26.7%) and pain (20.9%)with skilled manpower and the right instruments, no complications were sustained in 42.7% of the patients but due to repeated attempted removal some sustained ulceration (12.5%), nasal bleeding (44.8%) and unilateral foul discharge(16.1 %) in occult presentations.