A potential post-removal pH neutralization strategy to mitigate nasal button battery injuries

Button batteries (BBs) impacted in the nose of children can cause septal perforation, synechia, atrophy, necrosis and deformities such as saddle nose. Developing mitigation strategies that can reduce tissue damage after BB removal can decrease these complications.

3 V lithium BBs were placed on the cadaveric sheep nasal septum model segments. After 3, 6, 12 and 24 h, BB on each segment was removed and intermittent irrigation was performed with 0.25% acetic acid solution. Irrigation with saline was performed as the control. Visual tissue damage that occurred just before and after irrigation was photographed. BB voltage, temperature and pH changes in the tissue were recorded. Each segment was examined after irrigation for the depth of necrosis and presence of cartilage necrosis.

The voltage of 3 V lithium BB was observed to drop to about half at the end of the 3rd hour. It was observed that full-thickness mucoperichondrial necrosis occurred in the nasal septum segments at all time points. Although 0.25% acetic acid irrigation significantly decreased tissue pH compared to saline without increasing temperature, it did not show a significant superiority compared to saline in reducing neither visually nor histologically damage. While cartilage necrosis was not observed for the first 12 h, it was measured 105 μm in the segment irrigated with 0.25% acetic acid at the end of 24 h, and 518 μm in the segment irrigated with saline.

The pH neutralization strategy with post-removal 0.25% acetic acid irrigation to mitigate nasal BB injury appears to be ineffective in reducing the full-thickness mucoperichondrial necrosis starting within 3 h. Although this strategy seems to decrease the progression of cartilage necrosis starting after 12 h, the development of pre-removal strategies for the first 3 h may be more effective and superior in reducing mucoperichondrial damage.