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- Foreign body in ear or nose
Foreign body in ear or nose
One good attempt with the right technique — and batteries are an emergency.
| If you find… | …then |
|---|---|
| Button battery in nose or ear | Emergency — same-day ENT (tissue damage within hours) |
| Magnets (especially both nostrils) | Septal perforation risk — urgent ENT |
| Possible inhalation or ingestion (cough, choking, drooling) | ED — X-ray; batteries/magnets swallowed are emergencies |
| Uncooperative child / failed first attempt | ENT referral rather than repeated attempts |
- What, when, which side; witnessed?
- Choking, coughing, breathing difficulty
- Discharge (unilateral foul nasal discharge = retained FB)
- Previous attempts
- Good light, head mirror or otoscope
- Both nostrils/ears
- Chest if any choking history
The parent’s kiss
Explain to the parent and child first (“a big kiss”). Block the clear nostril with a finger; the parent seals their mouth over the child’s mouth and blows one short sharp breath. The object often pops out. Safe, painless and effective.
Know when to stop
Each failed attempt pushes objects deeper and loses the child’s cooperation. After one or two good attempts, refer to ENT.
Remove here or refer?
- Button battery
- Magnet(s)
- Possible inhalation or ingestion
- Failed first attempt or uncooperative child
- Trauma to canal / septum
Any present: ENT referral (same-day emergency for batteries) / ED if inhaled or swallowed. None present: Attempt removal in clinic (one or two attempts).
| Investigation | Only if… |
|---|---|
| X-ray | Only if swallowed or inhaled FB suspected (button battery/magnets) |
Management & advice
- Nose — “parent’s kiss”: occlude the clear nostril, parent seals mouth over child’s mouth and gives a sharp puff
- Nose/ear: forceps for graspable objects, wax hook / right-angled hook behind round objects
- Ear: irrigation for small inorganic objects (not batteries, not vegetable matter, not with perforation)
- Live insect in ear: drown with olive oil first, then remove
- Only one or two attempts — then ENT
Refer / follow-up
- Batteries, magnets, failed removal, trauma → ENT (urgent for batteries)
| Drug | Dose | Duration / notes |
|---|---|---|
| None routinely | Topical antibiotic drops only if canal trauma / otitis externa | — |
We’ve removed the object and there’s no sign of damage. A little bleeding or soreness for a day or two is normal. Come back if there’s ongoing discharge, smell, pain or bleeding, or straight away if they start coughing or have breathing problems, which can mean something went down into the chest.
Come back / call 111 — or 999 if severe — if:
- Bleeding, discharge or smell from the nose/ear after removal
- Ear pain, reduced hearing or discharge
- Any coughing, choking or breathing difficulty
Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.
There’s no national NHS page on this. Use your local leaflet.
- Irrigating a button battery or vegetable matter
- Repeated attempts on an upset child
- Not checking the other nostril/ear
- Missing a swallowed battery
Revision practice. Work through a real or imagined case to rehearse the reasoning. It builds a model note to learn from. It doesn’t replace your judgement, your seniors or local guidance.
✎Blank clinic note template
Foreign body in ear or nose — clinic note
Doses are typical doses drawn from the guidance above. Always confirm in the current BNF/BNFc and your local antimicrobial policy.