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| REPORT |
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| Year : 2010 | Volume
: 12
| Issue : 1 | Page : 29-30 |
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Button battery in the nasal cavity of a child for 3 years
Daefullah H Al-Amri
ORL-HNS specialist, Aseer Central Hospital, Abha, Saudi Arabia
| Date of Web Publication | 24-Dec-2019 |
Correspondence Address:
MD Daefullah H Al-Amri
ORL-HNS specialist, Aseer Central Hospital, Abha
Saudi Arabia
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/1319-8491.273971
This is a case report a child with a button battery in his nose for 3 years prior to his presentation to our hospital. The history was verified by the father and the help of x-rays which revealed the presence of a battery in the nose. The foreign body was removed under general anesthesia. The relevant history, physical examination, and the investigations are presented along with literature review.
Keywords: battery, nasal foreign body.
How to cite this article:
Al-Amri DH. Button battery in the nasal cavity of a child for 3 years. Saudi J Otorhinolaryngol Head Neck Surg 2010;12:29-30 |
| Introduction | |  |
Insertion of foreign bodies in the nose is one of the most common problems seen in children. Button batteries are becoming a common finding in these children. Children are in serious danger when allowed to play with small objects. Being small, they can be easily inserted into various orifices e.g. nose, ear and mouth [1]. In cooperative children these foreign bodies can be easily removed in the clinic. But as with any other foreign body, button batteries will need to be removed under general anaesthesia especially when they have been there for a long period of time. This is a case report of a child with a button battery left in the nasal cavity for 3 years due to lack of awareness and proper medical facilities.
| Case Report | | |
A 6 year old boy was seen in our clinic with a history of a foreign body in the nose since three years. According to the father the child inserted the foreign body (button battery) in his left nostril. He was taken to the nearest primary health care center in his village where multiple attempts failed to retrieve it out. It seems that this, unfortunately, lead to it being pushed to the back of the nasal cavity. The attending general practitioner advised the father to take his son to the nearest hospital. This was ignored by the father due to lack of awareness of the danger and lack of transport. During the last 3 years, the child continued to have unilateral nasal discharge and obstruction. Eventually the child was brought to our clinic. Examination of the nose revealed the presence of granulation tissues with black material seen in the floor of the nose far back near the posterior choana. The rest of ENT examination was within normal limits. Lateral view X-ray of the nose revealed the presence of metallic foreign body in the posterior nasal cavity [Figure 1]. Under general anesthesia examination of the nose showed the presence of granulation tissues which was removed along with the foreign body (button battery) [Figure 2], [Figure 3]. Second look showed ulceration of the mucosal surface of the posterior 1/3 of inferior turbinate and the corresponding part of the septum mainly the palatine crest in addition to the floor of the nose, but there was no evidence of septal perforation. Sialastic sheets were applied on both sides of the septum to prevent adhesion. | Figure 1: lateral nasal x-ray is showing the battery in the posterior part of the nose (arrow)
Click here to view |
Post-operative recovery was uneventful. He was put on a course of antibiotics cover and discharged home the next day. He was seen after one week when the sialastic sheets were removed. The patient was seen on subsequent weeks. The ulcerated area started to epthelialize. Three months follow up showed completely normal nasal cavities.
| Discussion | | |
Button batteries contain mercury, silver, zinc, manganese, cadmium, lithium, sulphur oxide, copper, brass, or steel. These are the components of the anode, cathode, and case containing the battery. Button batteries also contain sodium hydroxide or potassium hydroxide to facilitate the electrochemical reaction through the separator [2].
Etiology of the tissue damage appears to be threefold: 1) leakage of the battery contents with direct corrosive damage, 2) direct current effects on the mucosa, and 3) less likely, simple pressure necrosis. Experimental evidence implicates direct current as the primary cause of tissue destruction. The high electrolyte composition of tissue fluids generates a current between the battery cathode and the anode, resulting in the hydrolysis of tissue fluids and the generation of corrosive hydroxides [3]. The nasal injuries noted in the literatures included localized nasal mucosal necrosis, septal perforation, facial cellulitis. Lateral nasal button battery impaction may produce mucosal turbinate and septal ulceration in as little as three to six hours. Necrosis of the inferior turbinate has occurred at 24 hours. In this case, the foreign body the remained in the nose for 3 years.
| Conclusion | | |
Button batteries in the nose as well as all other foreign bodies are harmful; all effort should be done to remove them it as soon as possible. Good communication between primary health care centers and nearby hospitals should be done to facilitate the transfer of such emergencies.
| References | | |
| 1. | Loh WS, Leong JL ,Tan Hkk. Hazardous foreign bodies: complications and management of button batteries in nose. Ann Otol Rhinol Laryngol. 2003;112:379-83.  |
| 2. | Kalan A, Tariq M. Foreign bodies in the nasal cavities: a comprehensive review of the etiology, diagnostic pointers, and therapeutic measures. Postgrad Med.2000;76:484-7. |
| 3. | Alvi A, Bereliani A, Zahtz GD.Miniature disc battery in the nose: a dangerous foreign body. Clin Pediat.1997; 36:427-[Medline] |
[Figure 1], [Figure 2], [Figure 3]
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