Foreign bodies (FBs) in the ear, nose, and throat (ENT) region represent one of the most common emergencies encountered in otorhinolaryngology practice, particularly among the pediatric population. These cases account for a substantial proportion of emergency department visits and outpatient consultations, often requiring prompt diagnosis and intervention to prevent complications such as infection, tissue injury, airway compromise, and long-term morbidity.¹ Children are especially vulnerable because of their natural curiosity, tendency to explore body orifices, and lack of awareness regarding potential hazards.²

The epidemiology of ENT foreign bodies varies according to age, anatomical location, and sociocultural factors. Several studies have demonstrated that children younger than five years constitute the most affected age group, with a slight male predominance.³⁻⁵ The nose and ear are the most frequent sites of foreign body lodgement in children, whereas throat and esophageal foreign bodies are more commonly encountered in older children and adults.⁶ The nature of foreign bodies also varies by site; beads, seeds, toy parts, cotton pieces, insects, coins, and fish bones are among the most commonly reported objects.⁴˒⁷

The clinical presentation depends on the location and duration of impaction. Patients may present with nasal obstruction, foul-smelling nasal discharge, ear pain, hearing loss, foreign body sensation, dysphagia, odynophagia, or respiratory distress.⁸ Delayed presentation or inappropriate removal attempts may increase the risk of complications including epistaxis, canal abrasions, tympanic membrane injury, mucosal ulceration, aspiration, and secondary infections.⁹

Management of ENT foreign bodies requires adequate visualization, appropriate instrumentation, and selection of suitable removal techniques. Most ear and nasal foreign bodies can be removed in the outpatient setting using simple instruments; however, deeply impacted objects, uncooperative children, and airway-related foreign bodies may necessitate endoscopic removal or intervention under general anesthesia.⁵˒¹⁰ Previous studies have reported successful outpatient removal in the majority of cases, with relatively low complication rates when managed by trained otorhinolaryngologists.³˒⁶

Despite numerous reports from tertiary-care centers, data regarding the spectrum of ENT foreign bodies in rural healthcare settings remain limited. Understanding the local pattern of presentation, demographic characteristics, types of foreign bodies, and management outcomes is essential for planning preventive strategies and optimizing patient care. Therefore, the present study was undertaken to analyze ENT foreign bodies in terms of their type, site, age and gender distribution, and methods of removal in a rural tertiary-care hospital.

This retrospective observational study was conducted in the Department of Otorhinolaryngology of a rural tertiary care teaching hospital, CIMS Chamarajanagar to evaluate the spectrum of foreign bodies encountered in the ear, nose, and throat (ENT) region. The hospital serves as a major referral centre for the surrounding rural population and provides both emergency and elective otorhinolaryngology services. Study duration was 6 months. Data of patients diagnosed and managed for ENT foreign bodies between January 2020 and December 2024 were collected by verifying the records. A total of 110 patients with documented foreign bodies in the ear, nose, or throat were included in the study. Consecutive sampling of retrospective hospital records was employed, and all eligible cases meeting the selection criteria during the study period were reviewed until the required sample size was achieved. The sample size was determined based on the availability of complete medical records and was supported by similar retrospective studies in the literature that reported sample sizes ranging from approximately 100 to 110 patients. Patients of all age groups and both sexes with confirmed foreign bodies in the external auditory canal, nasal cavity, pharynx, larynx, hypopharynx, or upper aerodigestive tract were included. Cases with incomplete documentation, inadequate clinical information, prior removal attempts at other institutions, or foreign bodies involving regions outside the scope of otorhinolaryngology were excluded from the analysis. Data were collected from the Medical Record Department archives, ENT outpatient and emergency registers, inpatient case sheets, operation theatre records, and the Hospital Information System, where available. A structured data extraction proforma was used to ensure uniformity in data collection. The variables recorded included age, gender, site of foreign body lodgement, type and nature of foreign body, presenting symptoms, duration of symptoms, method of removal, requirement of anesthesia, complications encountered, and treatment outcomes. Foreign bodies were categorized according to their anatomical location into ear, nose, and throat groups. They were further classified as organic or inorganic based on their composition. The methods employed for removal, as documented in the records, included outpatient instrumental removal using routine ENT instruments, endoscopic removal, and removal under general anesthesia. Diagnostic and therapeutic procedures had been performed using standard otorhinolaryngological equipment, including otoscopes, rigid nasal endoscopes, Hopkins rod telescopes, flexible nasopharyngolaryngoscopes, suction devices, alligator forceps, Jobson-Horne probes, and Magill forceps, depending on the site and characteristics of the foreign body. Data were entered into Microsoft Excel and analyzed using SPSS version 22.0 (IBM SPSS Statistics, Somers, NY, USA). Descriptive statistics were used to summarize demographic and clinical characteristics. Continuous variables were expressed as mean ± standard deviation, whereas categorical variables were presented as frequencies and percentages. Associations between categorical variables such as age group, gender, site of foreign body, nature of foreign body, and method of removal were assessed using the Chi-square test or Fisher’s exact test, wherever appropriate. A p-value of less than 0.05 was considered statistically significant. Prior to commencement of the study, approval was obtained from the Institutional Ethics Committee (Approval No: CIMS/IEC-08/04/2024). As the study involved retrospective review of anonymized hospital records without direct patient contact, a waiver of informed consent was granted by the Ethics Committee. Patient confidentiality was maintained throughout the study by de-identifying all records before data extraction and analysis, and the study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.

A total of 110 patients with foreign bodies in the ear, nose, and throat were included in the study. The majority of patients belonged to the age group of less than 5 years (49.1%), followed by 5–10 years (29.1%). Patients aged 11–20 years constituted 11.8% of the study population, whereas only 10.0% were above 20 years of age. Nasal foreign bodies were predominantly observed among children younger than 5 years (61.3% of nasal cases), while ear foreign bodies were more evenly distributed among the pediatric age groups. Throat foreign bodies were encountered across different age groups with no clear age predominance. These findings indicate that foreign body insertion is primarily a problem of early childhood in the rural population studied. (Table 1)

Among the 110 patients studied, 64 (58.2%) were males and 46 (41.8%) were females, resulting in a male-to-female ratio of approximately 1.4:1. Male predominance was observed across all anatomical sites. Among patients with ear foreign bodies, 60.0% were males, while 56.5% of nasal foreign bodies and 62.5% of throat foreign bodies occurred in males. However, statistical analysis revealed no significant association between gender and the site of foreign body lodgement (χ² = 0.42, p = 0.81). This suggests that although males were more frequently affected, the anatomical distribution of foreign bodies was similar in both sexes. (Table 2)

The most commonly encountered foreign bodies were beads, accounting for 27.3% of all cases, followed by seeds and grains (23.6%), miscellaneous objects (14.5%), and cotton or paper pieces (13.6%). In the ear, beads were the most common foreign bodies (30.0%), followed by cotton or paper pieces (20.0%) and insects (17.5%). In the nose, seeds and grains constituted the largest group (32.3%), followed by beads (29.0%). All throat foreign bodies consisted mainly of coins (50.0%), fish bones (37.5%), and food bolus impaction (12.5%). Organic foreign bodies were more frequently encountered in the nose and throat, whereas inorganic objects predominated in the ear. (Table 3)

The majority of foreign bodies (80.9%) were successfully removed in the outpatient department using routine ENT instruments without the need for anesthesia. Outpatient instrumental removal was performed in 87.5% of ear foreign bodies and 87.1% of nasal foreign bodies. Endoscopic removal was required in 9.1% of cases, particularly for deeply impacted or poorly visualized foreign bodies. Removal under general anesthesia was necessary in 10.0% of patients and was most commonly required for throat foreign bodies, where 75.0% of cases underwent removal under general anesthesia. These findings indicate that most foreign bodies can be managed successfully in the outpatient setting, while a small proportion require operative intervention. (Table 4)

Most patients (91.8%) did not develop any complications. Complications were observed in 8.2% of cases overall. Among ear foreign bodies, canal abrasions were the most frequent complication, occurring in 5.0% of patients, while tympanic membrane injury was observed in 2.5%. Nasal foreign bodies were occasionally associated with epistaxis (3.2%) and mucosal edema (1.6%). In the throat, pharyngeal mucosal injury and secondary infection were noted in isolated cases. The low complication rate observed in the present study may be attributed to timely diagnosis and prompt management by otorhinolaryngologists. (Table 5)

Table 1: Distribution of Patients According to Age Group and Site of Foreign Body (n=110)

Table 2: Gender Distribution According to Site of Foreign Body (n=110)

Chi-square Test

Table 3: Distribution of Types of Foreign Bodies According to Site (n=110)

Table 4: Method of Removal According to Site of Foreign Body (n=110)

Table 5: Complications Associated with Foreign Bodies (n=110)

Complication rate =
= 8.2%

Foreign bodies in the ear, nose, and throat continue to be a common otorhinolaryngological emergency, particularly among children. In the present study, nearly half of the patients (49.1%) belonged to the age group below five years. Similar observations have been reported by Kwon et al., who found that early childhood constituted the largest proportion of ENT foreign body cases, and by Alhassan et al., who reported that more than 65% of affected children were younger than five years.²˒³ The high prevalence in this age group may be attributed to increased curiosity, exploratory behavior, and inadequate parental supervision. A male predominance (58.2%) was observed in the present study, which is consistent with findings reported by Alhassan et al., El-Taher, and Alqahtani et al., who documented a slightly higher incidence among boys.³˒⁶˒⁸ This trend has been attributed to greater physical activity and exploratory tendencies among male children. However, no significant association was found between gender and the anatomical site of foreign body lodgement, suggesting that both sexes exhibit similar patterns of foreign body insertion. The nose was the most common site of foreign body lodgement (56.4%), followed by the ear (36.4%) and throat (7.2%). This finding is comparable to the observations of Aksakal, who reported the nose as the commonest site, accounting for nearly 59% of cases.⁵ Similarly, Yılmaz reported that nasal foreign bodies constituted approximately 52% of pediatric ENT foreign bodies.⁴ In contrast, Kwon et al. reported the throat as the most common site in their pediatric emergency cohort.² Such variations may be explained by differences in study populations, age distribution, and healthcare-seeking behavior. Regarding the type of foreign bodies, beads and seeds were the most frequently encountered objects in the present study. Similar findings have been documented by Yılmaz and Aksakal, who identified beads as the most common foreign bodies in both the ear and nose.⁴˒⁵ Organic materials such as seeds were predominantly found in the nasal cavity, whereas coins and fish bones were the principal throat foreign bodies. These findings reflect the accessibility of these objects within the domestic environment and their frequent use by children during play. Most foreign bodies (80.9%) were removed successfully in the outpatient department using conventional ENT instruments. Only 10.0% required removal under general anesthesia, predominantly among patients with throat foreign bodies. Comparable rates have been reported by Yılmaz and Tuncer et al., where only a small proportion of patients required operative intervention under anesthesia.⁴˒⁷ This highlights the effectiveness of early referral and management by trained otorhinolaryngologists. The overall complication rate in the present study was low (8.2%), with canal abrasions, epistaxis, and minor mucosal injuries being the most frequent complications. Similar complication rates ranging from 5% to 12% have been reported in previous studies.⁶˒⁷˒⁹ The low incidence of complications observed in this study may be attributed to prompt diagnosis, appropriate instrumentation, and timely intervention. Overall, the findings of the present study corroborate existing literature and emphasize that ENT foreign bodies are predominantly a pediatric problem, commonly involving the nose and ear, and can be managed successfully with minimal complications when treated promptly by experienced clinicians.

Foreign bodies in the ear, nose, and throat remain a common otorhinolaryngological emergency, particularly among children younger than five years of age. In the present study, nasal foreign bodies were the most frequently encountered, followed by ear and throat foreign bodies, with a slight male predominance. Beads and seeds were the most common foreign bodies identified. The majority of cases were managed successfully in the outpatient setting using simple instrumental techniques, while only a small proportion required endoscopic removal or general anesthesia. Early diagnosis, prompt intervention, and parental awareness are essential to minimize complications and improve patient outcomes in rural healthcare settings.

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