Analyser une cohorte d’enfants admis aux urgences pédiatriques pour l’insertion nasale d’un corps étranger (CEN), détailler l’état actuel des connaissances sur le sujet.

Étude rétrospective incluant entre janvier 2003 et mai 2008, tout patient âgé de moins de 15 ans admis pour CEN. Les données collectées comportaient : âge, sexe, origine géographique, jour et heure d’admission, durée de séjour, délai d’insertion, tentative(s) d’extraction antérieure, symptômes, nature et localisation du CEN, mode d’extraction, recours à un ORL, examens radiologiques, devenir et complications éventuelles.

Three hundred and eighty-eight patients ont été inclus (393 CEN). Le sex-ratio était égal à 0,95, la moyenne d’âge égale à 3,5±1,6 ans, 71 % des patients avaient moins de 4 ans. Le délai d’insertion était inférieur à 4 h dans 65 % des cas, 88 % des enfants étaient asymptomatiques, le CEN était souvent logé dans la narine droite (65 %), cinq enfants avaient un CEN bilatéral. L’extraction était réalisée avec succès aux urgences dans 74 % des situations, elle était majoritairement réalisée par manœuvres instrumentales (82 %). La nature du CEN était dominée par les objets non organiques (80 %) : perle ou bille plastique (39 %), morceaux de plastique ou de jouets (20 %), caillou ou gravier (11 %), papier (6 %). Aucune complication n’a été enregistrée. Cinq enfants ont récidivé dans un délai moyen de 6 mois.

Accident fréquent et souvent banal, le CEN constitue une urgence en cas d’insertion d’une pile bouton ou d’un aimant en néodyme, en raison du risque de nécrose ou de perforation septale.

Provide a descriptive analysis of children admitted to a tertiary care pediatric emergency department (PED) for a nasal foreign body (NFB) and describe the current knowledge and management of such accidents.

A retrospective study was conducted from January 2003 to May 2008, including all patients aged less than 15 years admitted for a NFB. The data collected were age, sex, geographic origin, time and day of admission, duration in PED, duration of NFB insertion, nostril location, symptoms and clinical signs, prehospital extraction attempts, facial x-ray, extraction mode, referral to an ENT specialist, progression, and complications. For statistical analysis, the data were entered in Microsoft Excel spreadsheets. The data were analyzed with StatView 5.1 (SAS Institute^®) and EpiInfo 6.04fr (VF, ENSP Epiconcept^®). In the descriptive analysis, the data are presented as mean values with standard deviation, median with extreme values or with 95% confidence intervals where appropriate, unless otherwise indicated. To compare qualitative variables, a χ² test (Mantel-Haenszel) was used and the two-tailed Fisher exact test if the expected value was 5 or less. Statistical significance was set at p<0.05.

A total of 388 patients were included (393 NFB). The annual mean number of cases was 68. The annual distribution showed a higher number in January, March, April, and October following Christmas, Easter and Halloween celebrations, totaling 40% of all NFB admissions. The sex-ratio was 0.95. Children aged less than 4 years accounted for 71% of the studied population. The mean age was 3.5±1.6 years (range, 1.4–13 years). The majority of accidents occurred at home (95%). The length of time spent in the PED was 78±57 min. The NFB duration of insertion was unknown in one-quarter of cases, present for less than 4 h in 65% of cases. No symptoms were described in most cases (88%). When symptoms were described, bleeding, pain or nasal discomfort, and foul nasal odor were the principal symptoms. The right nostril was the predominant location (60%). This difference tended to disappear in the group of children aged less than 4 years. Five children had bilateral NFB. Nonorganic compounds accounted for 80% of the NFB: plastic beads or balls (39%), plastic or toy parts (20%), stones or pebbles (11%), and paper (6%). The extraction was instrumental in 82% of cases, and 26% of patients were referred to an ENT specialist when PED attempts were unsuccessful. One child needed hospitalization for extraction under general anesthesia of two beads located deep in the same nostril. No complication occurred. Five children had repeated accidents within an average delay of 6 months.

Often benign, this frequent accident can be serious in case of batteries or neodymium magnet insertion: the extraction becomes an emergency because of risks of nasal mucosa necrosis and/or nasal septum perforation. In other cases, positive pressure techniques (the parent’s kiss or its variants) could be tried first in the emergency department or at home at the time of a call to emergency services before a medical visit.