Injury Mechanism of Button Batteries in the Nasal Cavity and Possible Mitigation Strategies During Impaction

Abstract

Objective/Hypothesis Button batteries (BBs) impacted in the nasal cavity can cause several complications. Understanding the injury mechanism and developing possible mitigation strategies can reduce these complications. Study design Cadaveric sheep nasal septum model. Methods Lithium, alkaline, silver oxide, and zinc‐air BBs were placed on segments of the nasal septum of cadaveric sheep. The BB voltage, tissue temperatures, and pH were measured every 30 minutes for 6 hours. Subsequently, 5 drops of lemon juice, apple cider vinegar, tea, Coke (Coca‐Cola Co., Atlanta, GA), tap water, and normal saline were applied separately to the other segments with the lithium BBs every 10 minutes for 3 hours. The visible injuries and the necrosis depths were assessed through the tissue temperatures, pH, and the voltage changes. Results Both nonlithium and lithium BBs increased tissue pH without significant temperature changes. The 3V lithium BBs led to the greatest depth of necrosis, with a voltage loss of approximately 50% within the first 2 hours. Lemon juice and apple cider vinegar were the most effective liquids for reducing visible injury, pH, and necrosis without increasing the temperature during pre‐removal time period. Conclusion Nonlithium and lithium BBs caused alkaline tissue injury in a nasal septal model. Given the hazard severity, expedited BB removal is critical. For situations when removal cannot be immediately performed, further in vivo study is needed prior to considering human use of any pre‐removal mitigation strategies in the nasal cavity. Level of Evidence NA Laryngoscope, 130:2487–2493, 2020

Current management of button battery injuries

“…Patients with nasal cavity BB insertions may also present with rhinorrhea, nasal obstruction, epistaxis, facial swelling or periorbital cellulitis, and patients with ear canal BBs may present with ear pain or similarly to otitis externa. Nasal or ear canal BB insertions can lead to significant morbidity such as nasal septal perforations (Figure 3) or tympanic membrane perforations via a similar mechanism to BB ingestion 33 …”

“…Previous theories have posited that BB tissue damage occurs secondary to pressure injury, leakage of toxic contents, and electrolysis of water. However, studies have consistently shown that the primary mechanism of tissue injury is the electrolysis and production of hydroxide ions 18,33 . The electrical potential of BBs induces an isothermic water hydrolysis reaction at the junction of the BB negative pole and generation of hydroxide ions caused by the current created through the adjacent tissue, which essentially “connects the circuit” between the two poles of the BB.…”

Superabsorbent polymer balls as foreign bodies in the nasal cavities of children: our clinical experience

“…Most foreign bodies in paediatric patients are discovered promptly due to symptoms such as nasal congestion and runny noses, and they are largely treatable in the outpatient setting [ 1 ]. However, some specific nasal foreign bodies may cause severe damage to the nasal cavity and are associated with significant complications and sequelae [ 2 , 3 ]. In recent years, toys with superabsorbent polymer balls made of polyacrylate have become increasingly popular.…”

Uma Emergência Rinológica: Pilha na Fossa Nasal

“…7,8 Sancaktar et al, num estudo de modelo em cadáver, demonstraram que são necessárias apenas duas horas para que uma pilha possa provocar necrose dos tecidos. 9 Uma série publicada por Loh WS et al revelou que a partir de sete horas de impactação a percentagem de perfurações septais pode ser superior a 70%. 5 Dada a agressividade deste tipo de corpo estranho urge a necessidade de uma abordagem diagnóstica e terapêu-FIGURA 3.…”