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

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.

Cadaveric sheep nasal septum model.

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.

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.

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.

NA Laryngoscope, 130:2487-2493, 2020.