Paeds · ent-hearing-and-oral-health
Nasal foreign body and button-battery injury
Also known as Nasal foreign body in children · Button battery in the nose · Intranasal button battery · Paediatric nasal foreign body · Rhinolith · Nasal battery injury · Intranasal button battery injury
Fellowship topic on nasal foreign body and button-battery injury in children — an object lodged in the nasal cavity of a two-to-five-year-old, most often a benign inert bead, food or toy part presenting with unilateral foul-smelling or blood-stained discharge, with a single time-critical subtype, the button (coin) battery, that must be removed immediately because electrolysis at its negative pole generates hydroxide ions and alkaline liquefactive necrosis dissolves tissue within hours. Covers the common objects and the peak toddler age; the unilateral foul-discharge presentation and the rhinolith sequela; the alkaline-electrolysis, thermal and pressure-necrosis cascade that makes a battery burn the septum; the stepwise removal of inert objects by positive pressure (the parent's kiss) and instruments (alligator forceps for graspable objects, a right-angle hook behind a smooth bead, suction, a Katz extractor); the emergency removal of a button battery without waiting for fasting, cavity irrigation, the emerging role of topical neutralising agents, and ENT referral for burn surveillance; the avoidance of a blind finger sweep; the distinction of a battery from a coin by its step-off edge and double-ring sign; the complications of septal perforation, synechiae and stenosis; and ANZ, UK, US and Canadian guidance.
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Target exams
Red flags
- Any button (coin) battery seen in the nose, or a missing hearing-aid, remote or toy battery in a young child with unilateral symptoms — a time-critical emergency; remove immediately without waiting for a fasting period, because alkaline liquefactive necrosis at the negative pole dissolves septal tissue within hours.
- A unilateral foul-smelling and often blood-stained nasal discharge in a two-to-five-year-old — a nasal foreign body until proven otherwise, even when the child is well and denies insertion.
- A smooth round object such as a bead being grasped with forceps, pushing it deeper toward the airway — use a right-angle hook passed behind the object instead, and never perform a blind finger sweep.
- A nasal button battery that has been removed — look for a second battery and refer to ENT, because septal perforation, synechiae and stenosis can continue to evolve after the battery is out.
Life stages
Care settings
Clinical exam formats
Board mappings
- General Paediatrics and ENT: nasal foreign body in children — the unilateral foul-discharge presentation, the common objects, and the button battery as a time-critical emergency.
- Acute and safety care: positive-pressure and instrument removal, the avoidance of a blind finger sweep, and household button-battery safety education.
- Renewed curriculum — ENT and emergency care: the alkaline-electrolysis mechanism of battery injury, the removal-technique ladder, and the management of complications including septal perforation and rhinolith.
- Public health and systems: button-battery safety for families and remote retrieval pathways for the suspected nasal battery.
- General Paediatrics: recognition of the routine inert nasal foreign body versus the button-battery emergency, and the removal setting decision.
- Emergency and acute care: positive-pressure and instrument removal, immediate battery removal, and the safety-net and ENT referral after a burn.
- Long Case / Structured discussion: a child with a nasal foreign body or button battery — recognition, removal technique, complications and surveillance.
- Communication station: teaching a parent the parent's kiss technique and household button-battery safety, with a clear safety-net.
- Level 2 / 3 — ENT and emergency care: nasal foreign-body removal, the button-battery emergency, and the avoidance of a blind finger sweep.
- Health promotion: button-battery safety education for families and the prevention of nasal foreign-body insertion.
- Foundation of Practice (FOP): the presentation and first-line removal of a nasal foreign body, and the button battery as an emergency.
- Applied Knowledge in Practice (AKP): the alkaline-electrolysis mechanism, the removal-technique ladder, the distinguishing of a battery from a coin, and the complications.
- History-taking and management: the child with unilateral nasal discharge, the object history and the management plan including the button-battery emergency.
- Communication: teaching a parent the parent's kiss technique and button-battery safety advice.
- General Pediatrics Content Outline: nasal foreign body — presentation, removal techniques, the button-battery emergency and complications.
- Otolaryngology and Emergency Care: positive-pressure and instrument removal, battery mechanism and the avoidance of a blind finger sweep.
- Patient Care: timely recognition and direct-vision removal of nasal foreign bodies, immediate battery removal, and prompt recognition of complications.
- Systems-Based Practice and Population Health: button-battery safety education for families and rural retrieval pathways for the suspected battery.
- Medical Knowledge: the alkaline-electrolysis battery mechanism, the removal-technique ladder, and the distinction of a battery from a coin on imaging.
- Medical Expert: nasal foreign-body diagnosis and removal, the button-battery emergency and its complications, and the avoidance of a blind finger sweep.
- Health Advocate and Collaborator: button-battery safety education, culturally safe care for Indigenous and remote families, and timely ENT referral.
- Communicator: teaching the parent's kiss technique and household button-battery safety to families.
Overview & Definition
A father brings his three-year-old to the emergency department because "her nose has smelled awful for a week and now there is blood in the tissue when she wipes." She is otherwise well, eating and playing, and she insists she has put nothing up her nose. With a good light and her on her father's lap, anterior rhinoscopy shows a small foam toy piece resting on the floor of the right nasal cavity, surrounded by purulent discharge. Across the corridor, a different family is rushed in: a two-year-old who has just been found with a disassembled remote control and a missing button battery, and a parent who can see something shiny in one nostril. The first child is the common, benign, routine case. The second is the one that cannot wait. [1]
A nasal foreign body is any object, solid or semi-solid, lodged within the nasal cavity of a child. It is overwhelmingly a disease of the toddler and preschool years, when a child explores the world by inserting objects into orifices and lacks the judgement to remove them or to report them honestly. The objects span food, beads, toy parts, crayon, paper and coins, and increasingly button batteries taken from hearing aids, remotes, toys and key fobs. [1] [11]
What makes the topic examinable is the chasm between how benign most cases are and how dangerous one subtype is. The inert object irritates the mucosa and produces a foul unilateral discharge, and once removed the child is well. The button battery, by contrast, sets off a chemical cascade that destroys tissue within hours, turning a removable object into a septal perforation, a synechia or a saddle-nose deformity if it is not recognised. The fellowship task is to read the object, not the child, and to act on the battery immediately. [5] [3]
References12ShowHide
- [1]Lane Wilson J; et al Foreign Bodies in the Ear, Nose, and Throat. Am Fam Physician, 2025.PMID 40736491
- [2]Yan S; et al Characteristics and treatment of pediatric nasal foreign bodies with button batteries-A retrospective analysis of 176 cases. PLoS One, 2024.PMID 39208061
- [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
- [4]Xueyou L; et al Pediatric nasal button battery injuries: a 10-year retrospective study and in vitro evaluation of prehospital mitigation strategies. Eur J Med Res, 2026.PMID 41742308
- [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
- [8]Shaffer AD; et al Management and Outcomes of Button Batteries in the Aerodigestive Tract: A Multi-institutional Study. Laryngoscope, 2021.PMID 32068903
- [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
- [12]AlZabin A; et al Paediatric rhinolith: Case report and literature review. Int J Surg Case Rep, 2024.PMID 39522412