Patient Characteristics and Symptoms
During 2010-2019, a total of 847 children with suspected NFB were
admitted to the ED at our medical center. On physical examination, a NFB
was found in 562 (66%); these represented the study cohort. Sixty
percent of the patients were recorded as arriving within 24 hours
following the insertion, 7.5% within one week, and 5% after more than
one week. For 27% of the patients, the time of arrival to the ED was
unknown. Most of the children (82%) were asymptomatic upon arrival to
the ED, i.e. without any signs of nasal blockage or infection, such as
fever, foul odor, rhinorrhea, epistaxis or pain. The most common cause
for ED admittance among asymptomatic patients was a witnessed NFB
insertion (38%), followed by self-reported insertion by the child
(26%). The remaining asymptomatic patients (18%) were referred to the
ED by a caregiver (either a kindergarten teacher or a family doctor),
after the NFB was seen in the nose (usually with no knowledge of the
time of insertion). Among the symptomatic children (18%), the primary
symptoms were nasal discharge (10%), followed by epistaxis (8%) and
pain (4%). Fever was noted in only 2% of the patients, and nasal
blockage in 1.5%. All the children were hemodynamically and respiratory
stable upon arrival; none of them demonstrated respiratory symptoms.
NFB were recorded as inserted to the right nostril in 56% and to the
left in 25% (p<0.05), while in 19% of the children, the side
of insertion was not mentioned. Five percent of the patients had
comorbidities (asthma, allergy, cardiac abnormalities, developmental
delay and psychiatric disorders). Sixty-seven percent of the patients
(377 patients) were referred to examination by otolaryngologists during
the ED visit after first being treated by ED pediatricians. For 18% (68
patients), this was after failure to remove the NFB on the first
attempt. Twenty-six patients (4.5%) required general anesthesia for NFB
removal, which was always performed by otolaryngologists in the
operating room . None of the patients required ventilatory or pressure
support, nor the need for transfer to the intensive care unit following
the removal of the NFB. This suggests that none of the children had
aspirated the NFB. The overnight hospitalization rate was 5%. The
recurrence rate, i.e., more than a single episode of NFB, was 2%.
Characteristics of the cohort are presented in table 1.