RGUHS Nat. J. Pub. Heal. Sci Vol: 15 Issue: 1 eISSN: pISSN
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1ENT Department, Steel Authority of India Limited, IISCO Steel Plant, Burnpur Hospital, Asansol, West Bengal, India. E-mail: soumicksahoo@gmail.com
Abstract
Button batteries are the most hazardous foreign bodies reported in ENT practice. They can cause severe corrosive injury. The nasal cavities are one of the areas where a child accidentally inserts such foreign bodies. A 10-year-old male child was reported to the hospital with purulent rhinorrhea, mild nasal bleeding, and fever following the accidental insertion of a foreign body in the left nasal passage 1 day back. The foreign body was successfully removed in ENT OPD. It was confirmed as a button battery. It is concluded that such lethal foreign bodies should be urgently removed skillfully and diligently either in emergency or ENT OPD or under general anesthesia in the operation theatre.
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Introduction
Button batteries are the most dangerous foreign bodies seen in ENT practice. They can completely damage the mucosa and cause corrosive injuries. Button batteries are part of childhood toys, and the child may put them inside the nasal cavity out of curiosity. Such cases may be reported immediately or after many days as a neglected foreign body nose. The clinical symptoms and signs consists of nasal irritation, pain and burning sensation in the nose, foul-smelling profuse brownish-coloured nasal discharge, and bleeding from the nose.1 The case needs to be managed urgently with the removal of the button battery skillfully by an otorhinolaryngologist. One such rare case of button battery nose is being reported.
Case History
A 10-year-old male child was brought to the Emergency of the hospital by his parents with complaints of brownish purulent rhinorrhea and mild bleeding from the left nostril along with fever following insertion of an unknown foreign body in the left nasal passage one day back. On enquiring from child, he confessed to having put the foreign body in the left nasal passage one day back. The child was taken to the ENT OPD and on anterior rhinoscopy, purulent debris was seen. Suction cleaning was done diligently, and debris was cleared. A shiny metallic object was visible and it was carefully and diligently removed by probing and was confirmed to be a button battery. [Figure 1]. After the removal of the foreign body, anterior rhinoscopy was done again and findings included necrosis of the mucosa of nasal septum. The patient was prescribed antibiotic, antipyretic, and saline nasal drops, advised nasal douching, and to follow up periodically.
Discussion
Button battery in the nose was first reported in 1986.2,3 The clinical course of a child with a button battery depends on many factors such as the location, duration of exposure of mucosa, the remaining voltage in the battery, its age (new or old) and chemical composition of the battery.4,5,6
Litovitz has proposed various mechanisms of injury by these batteries to the mucosa such as spontaneous electrolyte leakage with liquefaction necrosis and cumulative tissue damage, corrosive effects of mercury oxide after leakage, impacted foreign body causing pressure necrosis, electric burn due to generation of an electric current.4,7
The impacted button battery in the nasal cavity can lead to complications such as mucosal and septal ulceration, chondritis, atrophic rhinitis, saddle nose deformities, and alar collapse.4,8
There may be a risk of secondary infections involving the regional structures leading to sinusitis, periorbital cellulitis, otitis media, and meningitis.2 Failure of immediate treatment may lead to sepsis and fatal toxic shock syndrome.2,9
Complications such as necrosis of nasal mucosa, scarring, septal perforation, synechiae in the nasal cavity, and stenosis of the nasal cavity are more likely to occur if the button battery is left behind in the nasal cavity for a long duration.4,10 Immediate removal of button battery has to be done diligently either in emergency or ENT OPD or Operation Theatre under General Anesthesia.
In the current reported case, the foreign body was immediately removed in the ENT OPD after obtaining consent from the parents and following the decision of the parents to opt for the removal of the foreign body without general anesthesia.
This case teaches the difference between the consequences of a simple nasal foreign body as compared to a dangerous nasal foreign body like a button battery. Button battery can produce unprecedented damage within a few minutes or hours. Such foreign body has to be immediately removed, otherwise, catastrophic complications may occur.
Conflicts of interest
Nil
Source of Funding
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Supporting File
References
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