MSRA ENT: Nasal Foreign Bodies & Polyps High-Yield Clinchers

🔴 Nasal Foreign Body – Key Points

✅ Typical Patient:

• Age: 1–5 years (toddlers)

• History clue: Playing with small objects, putting things in nostrils.

✅ Presentation:

• Onset: Acute (<24h)

• Laterality: Always unilateral

• Discharge: Thick, green, foul-smelling

• Systemic signs: No fever; child otherwise well.

✅ Common Foreign Bodies:

• Beads, buttons, toy parts, pebbles, food (peas), paper, cloth.

✅ Button Battery – RED FLAG:

• Causes septal necrosis and perforation within hours.

• Requires urgent ENT removal within <2 hours.

✅ Management:

• First-line: Parent’s kiss (positive-pressure technique) if visible and child cooperative.

• Otherwise: Instrumentation (forceps, hooks, cerumen loops), ENT referral if unsuccessful.

• Never irrigate if button battery or organic matter (swelling risk).

🔴 Nasal Polyps – Key Points

✅ Typical Patient:

• Young adults (20–40 years)

• Associations: Asthma, aspirin sensitivity (Samter’s triad).

✅ Presentation:

• Onset: Insidious, chronic.

• Laterality: Bilateral (unilateral → suspect tumour).

• Symptoms: Persistent nasal obstruction, clear or mucoid rhinorrhoea, hyposmia/anosmia.

✅ Pathology:

• Benign mucosal protrusions from sinus ostia/lateral wall.

✅ Samter’s Triad:

1. Asthma

2. Aspirin/NSAID sensitivity

3. Nasal polyps

✅ Management:

• First-line: Intranasal corticosteroids.

• If refractory: Endoscopic polypectomy ± aspirin desensitisation.

🔴 Unilateral Nasal Polyp – RED FLAG

✅ Why suspicious?

• Unilateral polyps in adults may indicate inverted papilloma or malignancy (e.g. SCC, esthesioneuroblastoma).

✅ Key Causes:

• Inverted papilloma: HPV-6, HPV-11 associated; risk of malignant transformation (5–15%).

• Fungal sinusitis: esp. in immunocompromised.

• Sinonasal tumours: SCC, lymphoma.

• Antrochoanal polyp: Common in children, benign.

✅ Red Flag Features:

• Epistaxis

• Facial pain/swelling

• Proptosis, diplopia, cranial nerve palsy

✅ Management:

• ENT referral for endoscopy ± biopsy.

• Imaging (CT/MRI) to assess extent.

🔴 Choana – Quick Anatomy Recall

✔️ Definition: Posterior nasal aperture connecting nasal cavity to nasopharynx.

✔️ Clinical relevance:

• Choanal atresia: Congenital blockage; bilateral causes neonatal emergency (cyanosis relieved by crying).

• Antrochoanal polyp: Polyp extends from maxillary sinus into choana and nasopharynx.

🔴 Rapid Differentiation Table

Feature	Nasal Foreign Body	Nasal Polyps
Age	Toddlers/young children	Young adults
Onset	Acute (<24h)	Insidious/chronic
Laterality	Unilateral	Bilateral
Discharge	Thick, green, foul	Clear/mucoid
Smell	Foul odour	Hyposmia/anosmia
Exam	Visible object	Smooth, pale, grape-like mass
Red Flag	Button battery	Unilateral mass (tumour)
Management	Removal (urgent if battery)	Steroids ± surgery

🔴 Mnemonics for Rapid Recall

✔️ “Foul & One” → Foul-smelling + Unilateral → Foreign body

✔️ “POLYP”

• Protruding mucosa

• Obstruction bilateral

• Loss of smell

• Young adult with asthma

• Precipitated by NSAIDs (Samter’s triad)

✅ Final Exam Clinchers

• Unilateral + foul + child → Foreign body

• Bilateral + anosmia + asthma + NSAID sensitivity → Nasal polyps

• Unilateral nasal polyp in adult → ENT referral to rule out malignancy

• Button battery → URGENT removal (<2h)

📚 References:

• https://apps.nhslothian.scot/refhelp/guidelines/paediatrics/paediatric-ent/foreignbodiesinearornosepaeds/

• https://www.royalberkshire.nhs.uk/media/niubs0uv/foreign-bodies-in-the-nose_dec23.pdf

• https://www.entuk.org/_userfiles/pages/files/guidelines/global%20ent%20guidelines/foreign_bodies_of_the_ear_and_nose.pdf

• https://www.nice.org.uk/guidance/ta648/documents/draft-scope-pre-referral