A rare case of polyembolokoilamania of nose in a neuropsychiatry patient

Nasal foreign body is common in children. In adults it is common among mentally retarded, psychiatric patients or is iatrogenic. As most of foreign body in a neuropsychiatry patient goes unnoticed, by the time the patient reaches the surgeon, it will be associated with its complications. So we as doctors should have this in back of mind when we examine a psychiatry or a mentally retarded patient and thorough clinical examination should be done irrespective of the patient’s complaints. We encountered a 25 year old male psychiatric patient presented with complaints of fullness and pain in both ears for three days. The patient had drug abused to cannabis, nicotine, alcohol and inhaling fevibond for four years. On examination bilateral tympanic membrane was intact with no signs of bleeding. Throat was clinically normal. Anterior rhinoscopy visualised a blackish hard mass with a yellowish green mucopurulent discharge in both the nasal cavity. On removal there were multiple variant foreign bodies and a large septal perforation in anterior aspect of septum was visualised. In psychiatry patients, there is a risk of foreign body insertions. This is a great challenge from clinical examination, diagnosing, removal to treating complications if any. Timely detection and prompt treatment will reduce medical morbidity. In this report we try to emphasize the importance of meticulous clinical examination in a psychiatric patient.