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.