An object that does not belong there – a “foreign body”.

Or, your 2-year-old has a foul smell, a bit like a piece of old fish, and there is some foul drainage from one side of her nose. Further investigation reveals that she has stuffed some upholstery foam into one side of her nose, resulting in rhinitis and sinusitis on that side (yuk!).

Common Nasal Foreign Bodies

Things (“foreign bodies”) that little boogorheads might put into their noses include:

• Beads,
• Buttons,
• Toy parts (shoe from Polly Pocket, for example),
• Pebbles,
• Food,
• Crumpled paper,
• Small disk batteries.

Don’t ask “why” – they just do.

Not an Emergency – Unless

Here is the important thing to keep in mind: this is not an emergency, UNLESS the foreign body is a disk or “button” battery.

A Disk Battery IS AN EMERGENCY.

If you suspect that your infant, toddler or child has placed a disk battery into their nose or ear canal, or that they may have SWALLOWED a disk battery, take them to the Emergency Department of your local Children’s Hospital.

Right Now.

Image: Nasal Foreign Bodes

The figure shows the most likely places for a bead or other foreign body to lodge in the nose – either high in the front of the nose (at the front of the “middle turbinate”, site #1), or against the “inferior turbinate” (site #2).

Things to DO

• Once you identify which side is affected, gently press the other nostril closed and have the child blow gently; this may blow the object free

Things NOT to DO

• Do not search the nose with cotton swabs or other tools – that may push the object further into the nose, where it may be aspirated (site #4 on the figure)
• Do not try to remove an object that you cannot see or grasp
• Do not use tweezers or other tools to attempt removal – you may create nasal trauma

Seek Professional Help If

• Bleeding develops or continues
• There is a foreign object in both nostrils
• You think that an infection has developed

Prevention

• Discourage your little boogorhead from putting objects into any body openings
• Keep small objects out of reach of infants and toddlers – especially button batteries

Treatment

Most of the time, your pediatrician or, more likely, your pediatric boogor doctor (Ear, Nose & Throat surgeon) will be able to remove an object from the nose in the clinic. Occasionally, due to a very wiggly, strong, or uncooperative child, this may need to be done in the operating room with the child sedated.

Your child may require surgery – general anesthetic – for removal of a nasal foreign body if the object is lodged securely, or if it is very deep. Anesthetic will keep your child comfortable and still, and help prevent further nasal trauma. If the object has caused a laceration to the lining of the nose it may require repair.

Emergency

To repeat:  if you think that your child may have placed a disk battery into their nose or ear canal, or may have swallowed a disk battery, take them to the Emergency Department of your local Children’s Hospital NOW.

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Hi, I’m Russell Faust, author of this medical education blog.

Image: Russell Faust

Let me know what topics are important to you and your child’s respiratory health. Join the conversation by leaving a comment / reply below, or email me any time.

Thanks for visiting, see you here later – we will be going into more detail on how to rid your children of allergies, rhinitis, sinusitis, and other chronic aero-digestive inflammatory disorders on this site.

If you are interested in these topics, please click here to subscribe to this blog (it’s FREE).

Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email.

It’s free, it’s convenient, it’s an easy way to stay up-t0-date on information to keep you and your family healthy.  You can un-subscribe at any time.

Stay informed.

Stay healthy.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

Part 2

When considering surgery for a child with chronic sinusitis …

When all else fails …

Last week I reviewed the first step in surgery to treat your child’s chronic sinusitis – adenoidectomy. We also talked about sinus centesis and new methods for identifying the bacteria that are causing the problem. Check out this link for Part 1 of “When Your Child Must Have Sinus Surgery“.

So, let’s assume that you have done EVERYTHING to eliminate your child’s chronic sinusitis. Let’s assume that you have followed my 5-Step Program to Eliminate Biofilm and Chronic Rhino-Sinusitis.

If all else fails and sinus surgery is absolutely indicated – perhaps your child has experienced one of the severe Complications of Sinusitis – the approach should always be minimally-invasive surgery:  minimal surgery for maximal gain, especially for a child.

Image: Balloon Sinuplasty Catheter

My own minimally-invasive preference for sinus surgery is “balloon sinuplasty” when possible, since there is minimal scarring, minimal post-operative crusting and bleeding, and excellent sinus openings are achieved. This is the method that I have been using for at least 5 years with great success.

This approach, balloon sinuplasty, has been found to have lasting results in adults.  Dr. Ramadan recently reported that balloon sinuplasty is also safe and effective in children, corroborating my own experience (Ramadan, 2009). In fact, there is a huge number of medical studies now that report excellent long-term results for Balloon Sinuplasty – with somewhere over 3,000 patients now!

Image: Medical Studies on Balloon Sinuplasty for Chronic Sinusitis

How Does Balloon Sinuplasty Work?

Most people have heard of cardiac balloon catheters – those are the balloons that are placed into the coronary arteries, and expanded to open the arteries, as an alternative to coronary artery bypass surgery.

For balloon sinuplasty, a similar balloon catheter is placed into the normal openings of the sinuses (called the sinus ostea), and expanded to stretch open the ostea. [Check here for the Anatomy of the Nose and Sinuses].

Balloon Sinuplasty: No cutting. No tearing or ripping the tissue. As a result, there is less bleeding, less potential for scarring, less post-op care required at home, and in clinic. Long-term follow up has shown excellent results.

The 4 steps to Balloon Sinuplasty:

1. Place the Balloon Catheter
   

   Image: Balloon Sinuplasty to Treat Chronic Sinusitis - Placing the Balloon

2. Inflate Balloon Catheter

   

   Image: Balloon Sinuplasty to Treat Chronic Sinusitis – Inflating the Balloon

3. Deflate Balloon Catheter

   

   Image: Balloon Sinuplasty to Treat Chronic Sinusitis – Deflating the Balloon

4. Remove the Catheter

   

   Image: Balloon Sinuplasty to Treat Chronic Sinusitis – After Removal of the Catheter

Images courtesy of Frederick Kuhn, MD

All of these steps in children require a general anesthetic. For adults, some sinus surgeons are actually offering Balloon Sinuplasty in their clinics, without the need for general anesthetic.

Results:

Overall, my pediatric patients have achieved greater than 90% success with balloon sinuplasty! That is impressive, given that I will only perform sinus surgery for those children who fail every other possible medical and surgical treatment – including long-term nasal saline rinses, long-term antibiotics, and an adenoidectomy – before I will consider sinus surgery. That means that these children have chronic sinusitis that is particularly difficult to treat, by ANY means.

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Watch the Balloon Sinuplasty Video / animation

on the Acclarent website:

http://www.balloonsinuplasty.com/balloon_video.cfm

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Transparency: I have no financial or other ties to the vendor of this surgical system (Acclarent Medical). I recommend those who are curious to check out their website.

Important:

If the care of your child does progress to the point of sinus surgery, keep in mind that exposure to tobacco smoke will significantly reduce the success rate of the surgery (Ramadan & Hinerman, 2002). Just one more reason to Quit Smoking, and to Eliminate Your Smoke Exposure – keep smokers away from you and your children!

Resources

Ann L. Griffen, Clifford J. Beall, Noah D. Firestone, Erin L. Gross, James M. DiFranco, Jori H. Hardman,Bastienne Vriesendorp, Russell A. Faust, Daniel A. Janies, Eugene J. Leys. CORE: A Phylogenetically-Curated 16S rDNA Database of the Core Oral Microbiome; PLoS ONE, 2011:http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0019051

Faust RA and Rimell FL: Chronic rhinosinusitis in children. Current Opinion in Otolaryngology, Head and Neck Surgery, vol. 4: 373-377, 1996.

Ramadan HH, Cost JL: Outcome of adenoidectomy versus adenoidectomy with maxillary sinus wash for chronic rhinosinusitis in children. Laryngoscope Vol. 118: 871-873; 2008.

Ramadan HH: Safety and Feasibility of Balloon Sinuplasty for Treatment of Chronic Rhinosinusitis in Children. Annals of Otology, Rhinology & Laryngology. Vol. 118(3): 161-165; 2009

Ramadan HH, Hinerman RA. Smoke exposure and outcome of endoscopic sinus surgery in children. Otolaryngology Head & Neck Surgery. Vol. 127(6): 546-548; 2002.

Acclarent Balloon Sinuplasty: http://www.acclarent.com/solutions/overview/

_______________

Hi, I’m Russell Faust, author of this blog, and I appreciate your comments and questions.  Keep ‘em coming.  Please, “be excellent to one another.”

I invite you to subscribe (it’s FREE) to this blog for weekly updates – you won’t be swamped by updates, I simply cannot write for the blog everyday.

Click here to receive free weekly updates: (http://eepurl.com/FGnP)

Type in your best email address (the one you actually use).

Your email is safe - will never be shared or sold. Ever.

Click here to read our Privacy Policy: http://wp.me/PR4iB-r

When the confirmation email from boogor doctor arrives, click on the link to give your okay to receive free weekly updates, occasional book reviews or product reviews, occasional discount-coupons for products that I use (not affiliates), all without needing to visit the website.

It’s free, it’s convenient. No ads. No spam. You can un-subscribe at any time. How cool is that?

Stay Informed.

Stay Healthy.

Best of health and success to you and your families.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)

Part 1

When considering surgery for a child with chronic sinusitis …

Before even considering sinus surgery for a child, I insist that a strong, integrative holistic medical approach has been tried, and failed. All other options must have been exhausted.  This includes doing daily sinus rinses. Really doing them.  Really.  Check this link for my 5-Step Program to Eliminate Biofilm and Chronic Rhino-Sinusitis.

It also means a thorough evaluation for why this child is having chronic sinusitis. After all, chronic infection is not normal, and it may reflect underlying pathology such as immune deficiency, or other severe disease. Only after we rule out ALL other, correct-able issues, so we move on to consider surgery.

A computed tomographic (CT) scan can reveal the condition of the sinuses, and whether there is obstructing adenoid growth in the nasopharynx or obstruction of the sinus openings. Check this link for How To Read Your Child’s Sinus CT Scan.

In my practice, even if the child’s adenoid tissue appears small on the CT scan, I will still consider an adenoidectomy to be the first surgery step for my patients with chronic sinusitis. Why? Removing the adenoid tissue can eliminate a potential reservoir of bacteria near the nose and sinuses. Check this link for more on the Anatomy of the Nose and Sinuses.

Also, if the child has been on multiple courses of antibiotics, there is increased risk of resistant bacteria being present in the sinuses. That is, the bacteria that are present are often resistant to most of our antibiotics. In order to treat those resistant bacterial infections, it can be very helpful to determine what bacteria are causing your child’s sinusitis.

How can we find out which bacteria are present?

If my patients go to surgery for an adenoidectomy, that is a good time to irrigate their maxillary (cheek) sinuses and send this for culture to identify the bacteria that are present (Faust, Rimell, 1996); the term for this procedure is “sinus centesis”. Knowing the types of bacteria that are present, and which antibiotics that are effective against them, can be useful for fighting chronic sinusitis.

Unfortunately, culture of sinus infections may not always reveal all of the bacteria that are present. The latest technique is to clone the DNA of bacteria that are present, and compare them to a database of known bacterial species. This method reveals that culture methods can miss a large number of bacteria. Check this link for thevery latest methods for identifying bacteria in the aero-digestive tract (Griffen & colleagues, 2011).

The time of an adenoidectomy is also the time to perform a “wash,” or irrigation, of the maxillary sinuses.  Rinsing out the sinuses while under general anesthetic greatly increases the success over just doing adenoidectomy alone to treat chronic sinusitis (Ramdan & Cost, 2008).

Finally, there is never a downside to performing daily nasal saline rinses. I use the Nasopure nasal rinse system for myself and my family, and this is the system that I recommend to my patients.

Transparency: I have no financial or other arrangements with Nasopure.com, and by-the-way, they have THE best videos of how to do nasal rinses on their site! Check it out. Those videos were the only way that I could get my 5-year-old to try it.

Next Time: I will review my preferred method of minimally-invasive sinus surgery.

_______________

Resources

Faust RA and Rimell FL: Chronic rhinosinusitis in children. Current Opinion in Otolaryngology, Head and Neck Surgery, vol. 4: 373-377, 1996.

Ramadan HH, Cost JL: Outcome of adenoidectomy versus adenoidectomy with maxillary sinus wash for chronic rhinosinusitis in children. Laryngoscope Vol. 118: 871-873; 2008.

Ramadan HH: Safety and Feasibility of Balloon Sinuplasty for Treatment of Chronic Rhinosinusitis in Children. Annals of Otology, Rhinology & Laryngology. Vol. 118(3): 161-165; 2009

Ann L. Griffen, Clifford J. Beall, Noah D. Firestone, Erin L. Gross, James M. DiFranco, Jori H. Hardman,Bastienne Vriesendorp, Russell A. Faust, Daniel A. Janies, Eugene J. Leys. CORE: A Phylogenetically-Curated 16S rDNA Database of the Core Oral Microbiome; PLoS ONE, 2011: http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0019051

Acclarent Balloon Sinuplasty: http://www.acclarent.com/solutions/overview/

_______________

Image: Russell Faust, aka the boogordoctor

Hi, I’m Russell Faust, author of this blog, and I appreciate your comments and questions.  Keep ‘em coming.  Please, “be excellent to one another.”

I invite you to subscribe (it’s FREE) to this blog for weekly updates – you won’t be swamped by updates, I simply cannot write for the blog everyday.

Click here to receive free weekly updates: (http://eepurl.com/FGnP)

Type in your best email address (the one you actually use).

Your email is safe - will never be shared or sold. Ever.

Click here to read our Privacy Policy: http://wp.me/PR4iB-r

When the confirmation email from boogor doctor arrives, click on the link to give your okay to receive free weekly updates, occasional book reviews or product reviews, occasional discount-coupons for products that I use (not affiliates), all without needing to visit the website.

It’s free, it’s convenient. No ads. No spam. You can un-subscribe at any time. How cool is that?

Stay Informed.

Stay Healthy.

Best of health and success to you and your families.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)

I recently thanked y’all for making my first ever blogging experience a good one. I have met many friends through this blog, and according to emails and comments, have helped some children (and a few adults) reduce or eliminate symptoms from their respiratory disorders.

My mission is to educate, and help families make informed choices regarding the health of their children.

From my perspective, this blog – boogordoctor.com – has been a success. It has been a great year, thanks to all of you – the readers of this blog site, and subscribers of email updates.

I want to especially thank those of you who take the time to leave comments or email me with comments and questions. I really appreciate your commitment to our little community of “boogor heads”.

In case you are new to this site, or joined us only recently, here is a list of the Top 15 Most Popular articles over this first year (most popular first):

8 Dangerous Complications of Sinusitis, But 3 That Can Kill

Illustrated review of the complications of sinusitis, categorized into intracranial, orbital, and local.

Nasal and Sinus Anatomy (and Histology)

Extensive illustrated review of nasal and sinus anatomy. Helpful foundation for understanding your child’s sinusitis.

Top 10 Food Allergens

A review of the 10 most common food allergies, and what to do if you suspect that your child has food allergies.

Anatomy of Nose Bleeds in Children

An illustrated review of the anatomy of nose bleeds in children.

Saline Sinus Rinses

The last in a series of how-to articles on saline nasal rinses for managing rhinitis and sinusitis: recipes, things that can be added to improve results, how often to do the rinses, etc.

TESTING: CT Imaging the Sinuses

Illustrated guide to Sinus CT scans: how to “read” a sinus CT image.

Reflux and Otitis: Does GERD Cause Ear Infections?

Illustrated review of the medical evidence for the role of reflux in ear infections, and how to use that information for you child.

3 Year Old Boy Hospitalized for Sinus Infection: Simple Cure

Illustrated case review of a young boy who was hospitalized for severe chronic sinusitis, and how we saved him some major surgery.

8 Choking Hazards for Babies and Infants

Illustrated review of food choking hazards for little tykes, how to minimize the risk, and what to do if you suspect that you infant has choked on something.

Honey: Nature’s Antibiotic

Review of nature’s strong antibiotic – honey: why it is such a strong anti-bacterial, and how to use that information.

Your Child’s Nose is Bleeding: What to do Right Now

Brief review for managing your child’s nose bleed.

Use Plants to Purify and Detoxify Your Air

An interesting story about how a man dying from severe asthma in India, and some NASA research, found that plants can purify our air.

It’s All Connected (Unified Airway and Sinusitis, Otitis, Rhinitis, Asthma, …)

How the Unified Airway model explains the connection between reflux, ear infections, sinusitis, and many other disorders of the aero-digestive tract.

8 Principles to Control Your Child’s Sinusitis

8 simple steps that can help you eliminate your child’s sinusitis.

What is the Unified Airway?

Illustrated explanation of the Unified Airway Model.

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Image Credit:

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Thanks for visiting.

I appreciate your comments and questions.  Keep ‘em coming.  Please, “be excellent to one another.”

I invite you to subscribe (it’s FREE) to this blog for weekly updates – you won’t be swamped by updates, I simply cannot write for the blog everyday.

Click here to receive free weekly updates: (http://eepurl.com/FGnP)

Type in your best email address (the one you actually use).

Your email is safe - will never be shared or sold. Ever.

Click here to read our Privacy Policy: http://wp.me/PR4iB-r

When the confirmation email from boogor doctor arrives, click on the link to give your okay to receive free weekly updates, occasional book reviews or product reviews, occasional discount-coupons for products that I use (not affiliates), all without needing to visit the website.

It’s free, it’s convenient. No ads. No spam. You can un-subscribe at any time. How cool is that?

Stay Informed.

Stay Healthy.

Best of health and success to you and your families.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)