Button Battery Nasal Foreign Body

Nose Problem

Button Battery Nasal Foreign Body

We have all seen our share of objects in places that they are not supposed to be.  Certainly we strive to remove these foreign objects without causing any more harm, but occasionally are not successful and defer to our friends with specialized tools.  But, there are some types of Foreign Bodies that demand a little more respect and require more emergent care.  The Watch / Button Battery Nasal Foreign Body is one specific instance.

Button Batteries as Foreign Bodies

  • From 1997 to 2010, an estimated 40,400 children (<13 years of age) were treated in US EDs for battery-related injuries!
  • 10% required hospitalization.
  • There were 14 fatal injuries (12 of which were documented to be due to Button Batteries).
  • One study found that 76% were swallowed, followed by 10% being Nasal Foreign Bodies.

The Problem with Button Batteries in the Nose

  • Button batteries can lead to serious tissue destruction in a relatively short amount of time.
  • Alkaline batteries lead to liquefaction necrosis (so the more time they are exposed to the tissue the more damage the alkaline material will do… essentially eroding through mucosa, down to cartilage and eventually through the septum.
  • They can cause devastating deformities.
  • There is a plethora of ENT literature that document the potential destructive forces that are at play.
  • “Batteries found in the nasal cavities should be removed IMMEDIATELY to prevent sequelae such as septal perforations or nasal meatus stenosis.” (Gomes, 1994)

“Time is Nose!”

  • Ok, maybe that isn’t a real saying… but perhaps it should be.
  • Of course we are well versed with removing Nasal Foreign Bodies.  See Morsel for some basics.
  • The problem is that the tissue destruction is occurring and leading to edema and possibly entrapping the battery within the mucosa.  The battery can then be difficult to remove.
  • Naturally, consulting an ENT / Plastic surgeon will be warranted to help manage the patients dissolving nasal passage… but, Time is Nose (as “they” say) and you don’t have time to wait for the ENT / Plastics arrive.  You really need to get this battery out.

If all else fails, try a snare!

  • Published in this month’s Journal of Emergency Medicine, there is a handy trick to know.
  • I encourage you to read through the technique… but to not plagiarize, here is what they say:

A 24-guage wire “snare” loop was created, inserted into the nasal aperture, and used to dissect a plane between the battery and the septal, turbinate, and nasal floor mucosa until all sides were free.  Once the posterior free edge of the battery was palpable with the loop, it was rotated 90 degrees and retracted outward, freeing the nasal foreign body and bringing it forward. At this point, the battery was visualized in the alar vestibule and removed with forceps.”

Snare Technique

Snare Technique

Naturally, this requires a very cooperative patient… perhaps chemically induced cooperation will be required.

Keep this in your bag o’ tricks to perhaps save a nose!

 
Fundakowaski CE, Moon S, Torres L. The snare technique: A novel atraumatic method for the removal of difficult nasal foreign bodies. J of Emerg Med. 2013; 44(1): 104-106.
 
Center for Disease Control and Prevention. Injuries from batteries among children aged <13 years — United States 1995 – 2010. MMWR. 2012; 61(34): 661-666.
 
Sharpe SJ, Rochette LM, Smith GA. Pediatric battery-related emergency department visits in the United States, 1990-2009. Pediatrics. 2012; 129(6): 1111-1117.
 
Gomes CC, Sakano E, Lucchezi MC, Porto PR. Button battery as a foreign body in the nasal cavities. Special aspects. Rhinology. 1994; 32(2): 98-100.
 
 
 

Sean Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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