A 4-year-old boy with unilateral odorous, mucopurulent nasal discharge for the past week; right-sided purulent bleeding discharge and what appears to be a sponge blocking the nares. Which is the most appropriate management?

A 4-year-old boy with unilateral odorous, mucopurulent nasal discharge for the past week; right-sided purulent bleeding discharge and what appears to be a sponge blocking the nares. Which is the most appropriate management?

• A. Reassurance
• B. Attempt removal at the clinic
• C. Start antibiotics
• D. Refer to ENT

Answer: (B)

The key issue here is a nasal foreign body presenting with unilateral, foul-smelling discharge. A sponge seen blocking the nostril strongly suggests a object lodged in the nasal cavity. The best next step is to remove it in the clinic. Removing the object directly addresses the cause of the symptoms, rapidly relieves obstruction, and reduces the risk of ongoing infection or complications like significant bleeding or abrasion of the nasal mucosa. Antibiotics alone wouldn’t fix the obstruction or odor and reassurance wouldn’t resolve the foreign body. Referral to ENT is appropriate only if the object cannot be removed in clinic, if removal is unsafe, or if complications arise. If removal is attempted and unsuccessful, or if the object is deeply seated or posterior, then ENT evaluation is warranted. In this scenario, attempting removal at the clinic is the most appropriate initial management.

The key issue here is a nasal foreign body presenting with unilateral, foul-smelling discharge. A sponge seen blocking the nostril strongly suggests a object lodged in the nasal cavity. The best next step is to remove it in the clinic. Removing the object directly addresses the cause of the symptoms, rapidly relieves obstruction, and reduces the risk of ongoing infection or complications like significant bleeding or abrasion of the nasal mucosa. Antibiotics alone wouldn’t fix the obstruction or odor and reassurance wouldn’t resolve the foreign body. Referral to ENT is appropriate only if the object cannot be removed in clinic, if removal is unsafe, or if complications arise. If removal is attempted and unsuccessful, or if the object is deeply seated or posterior, then ENT evaluation is warranted. In this scenario, attempting removal at the clinic is the most appropriate initial management.