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.