Nasal foreign body and button-battery injury — structured clinical encounter

Structured encounter testing the approach to a two-year-old with a missing button battery and a disc wedged against the nasal septum: the emergency-removal decision that does not wait for fasting, the alkaline-electrolysis mechanism, the avoidance of a blind finger sweep, and the second-battery check and ENT referral after removal, with a pivot to a four-year-old with a unilateral foul discharge and a smooth bead testing the positive-pressure technique and the right-instrument choice.

structured clinical encounter2 min readVerification in progress

Prompt

A two-year-old boy is brought to the emergency department after a button battery went missing from a remote control. He is well and afebrile, but on anterior rhinoscopy a shiny metallic disc is wedged firmly against the right side of the nasal septum. He ate 30 minutes ago. You are the paediatric registrar working through the emergency-removal decision, the mechanism, the second-battery check and the ENT referral, and a later scenario of a four-year-old with a unilateral foul-smelling blood-stained discharge and a smooth round bead.

Candidate brief

You are the paediatric registrar in the emergency department. A two-year-old boy is brought in after a button battery went missing from a remote control. He is well and afebrile, but on anterior rhinoscopy a shiny metallic disc is wedged firmly against the right side of the nasal septum. He ate 30 minutes ago, with no bleeding disorder and no prior removal attempts. [3]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References8Show ledger

[1]Lane Wilson J; et al Foreign Bodies in the Ear, Nose, and Throat. Am Fam Physician, 2025.PMID 40736491
[3]Heilig Y; et al Long-term outcomes following nasal button battery foreign body injuries in children: a 10-year retrospective analysis of 45 patients. Int J Pediatr Otorhinolaryngol, 2026.PMID 41985339
[5]Craft A; et al Current State of Button Battery Ingestion Injuries. Otolaryngol Clin North Am, 2026.PMID 42342488
[6]Sethia R; et al Current management of button battery injuries. Laryngoscope Investig Otolaryngol, 2021.PMID 34195377
[7]Jatana KR; et al Initial clinical application of tissue pH neutralization after esophageal button battery removal in children. Laryngoscope, 2019.PMID 30835848
[9]Bance RRR; et al To X-Ray or Not to X-Ray? Discussing Unknown Nasal Foreign Bodies and Button Batteries. Ear Nose Throat J, 2024.PMID 34338035
[10]de la O-Cavazos M; et al A new positive-pressure device for nasal foreign body removal. Pediatr Emerg Care, 2014.PMID 24457495
[11]Thompson J; et al Pediatric nasal foreign body not visible on simple exam: Incidence and patient characteristics. Am J Emerg Med, 2025.PMID 40803278