Characteristics and Outcomes According to Age Groups
Age was the prognostic factor examined that most strongly associated with presenting symptoms, the type of NFB material, failure rates, the use of general anesthesia and overall complications. In children under age 4 years, 39% of NFB were organic, compared to only 19% in older children (OR=2.64, p<0.05). This difference may be partially explained by lesser exposure of younger children to small nonorganic toys, beads and batteries due to safety reasons. In contrast, organic materials (seeds, fruits, etc.) are more commonly within toddlers’ reach. For 70% of older patients, medical attention was sought within the first 24 hours, compared to only 55% of younger patients (OR=1.9, p=0.03). Older children can better express themselves to their parents and are more capable of conveying discomfort due to NFB. In our cohort, younger patients were more prone to insert NFB into the right nostril (OR=1.43, p=0.04). Insertion of NFB to the ipsilateral rather than the contralateral side presumably requires less coordination abilities, and is thus easier for younger children. The overall complication rate did not differ according to the duration of NFB in the nasal cavity (data not presented). Nasal discharge, which was the most common presenting symptom, was more common in younger than older patients (14% vs. 8%), although the difference was not statistically significant. This is especially important for the general practitioner who may encounter a child with a unilateral nasal discharge. In younger patients who are not always able to express their complaints, a chronic unilateral nasal discharge can be a crucial diagnostic sign. Notably, nasal blockage and fever were both rare in our cohort. In younger children, the nasal cavity is anatomically smaller, which increases the challenge of removing NFB in the first attempt. In our cohort, failed attempts were more common among younger patients (11% vs 7.5%). Older children, on the other hand, are more difficult to hold while they resist physical examination, which lower the likelihood of safe removal in the ED. Among our older patients, the risk for removal under general anesthesia was higher (5.5% vs 2.8%), as was the overall rate of complications (5.5% vs. 4.6%). Although these age-related differences were not statistically significant, a trend was demonstrated.