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This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.
Key points
- Common in children aged 2–5 years
- Nasal button battery: EMERGENCY — mucosal necrosis within 2 hours. Remove IMMEDIATELY
- Ear FB: microsuction/forceps. Do NOT syringe vegetable matter (swells). One ED attempt then ENT
- Nasal FB: try "mother's kiss" first. If fails → ENT removal
- Airway FB: back blows/thrusts (choking protocol). If persistent → rigid bronchoscopy
- Unilateral foul-smelling nasal discharge in a child = retained FB until proven otherwise
Overview
ENT foreign bodies are common in children aged 2–5. Ear FBs include beads, toys, insects. The critical nasal emergency is a button battery causing chemical burns and septal perforation within hours. Inhaled FBs (peanuts, small objects) lodge usually in the right main bronchus (wider, more vertical).
Epidemiology
A significant proportion of paediatric emergency attendances. Nasal FBs most common, then ear, then airway. Button battery injuries increasing. Airway FB aspiration is a leading cause of accidental death in children <3.
Clinical Features
Symptoms
Ear: pain, hearing loss, buzzing (insect)
Nose: unilateral foul-smelling discharge, obstruction, epistaxis
Airway: sudden choking, coughing, stridor, unilateral wheeze
Persistent unilateral wheeze not responding to bronchodilators — suspect inhaled FB
Signs
FB visible on otoscopy or rhinoscopy
Button battery: grey disc, double ring on X-ray
Unilateral reduced air entry or wheeze (airway FB)
Cyanosis, inability to speak — complete obstruction
Investigations
First-line
Direct visualisationOtoscopy or rhinoscopy
Second-line
X-rayButton battery (double-ring sign), radio-opaque airway FB, hyperinflated hemithorax
CXR inspiratory + expiratoryAir trapping on expiration with airway FB
Specialist
Rigid bronchoscopyGold-standard for inhaled FB removal under GA
Management
Resuscitation Council UK and ENT UK1
Ear FB
- Insect: drown with olive oil/lidocaine drops first
- Remove with forceps, microsuction, syringing (NOT vegetable matter)
- Max ONE attempt in ED — then ENT under GA
2
Nasal FB
- Button battery: IMMEDIATE removal — ENT emergency
- "Mother's kiss": occlude unaffected nostril, parent blows into child's mouth
- Removal under direct vision with headlight + forceps/probe
- Uncooperative child: ENT under GA
3
Airway FB — choking
- Infant <1 yr: 5 back blows → 5 chest thrusts
- Child >1 yr/adult: 5 back blows → 5 abdominal thrusts
- Unconscious: CPR, call 999
- NO blind finger sweep
4
Retained airway FB
- Persistent cough/wheeze/recurrent pneumonia → CXR → rigid bronchoscopy under GA
Complications
- Button battery necrosis: Septal perforation, oesophageal fistula — potentially fatal
- TM perforation: From failed ear FB removal
- Post-obstructive pneumonia: Retained airway FB
- Asphyxiation
UKMLA Exam Tips
- 1Unilateral foul-smelling nasal discharge in child = nasal FB
- 2Button battery = EMERGENCY — necrosis within 2 hours, double-ring on X-ray
- 3Inhaled FB: right main bronchus most common
- 4Unilateral wheeze + choking history + normal CXR → still suspect FB → bronchoscopy
- 5Choking: back blows then chest thrusts (infant) or abdominal thrusts (child >1). No blind finger sweep
- 6Do NOT syringe ear with vegetable matter (swells)
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