Paeds Vivas · ent-hearing-and-oral-health
Nasal foreign body and button-battery injury — branching viva
Branching viva from a two-year-old with a missing remote-control battery and a disc seen against the nasal septum, testing the emergency-removal decision and the alkaline-electrolysis mechanism, through the stepwise removal of an inert object and the instrument choice for a smooth bead, with a pivot to a four-year-old with unilateral foul discharge testing the diagnostic maxim and the contraindicated manoeuvre, and a final probe on the battery-versus-coin distinction and the complications to surveil after removal.
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Opening — the two-year-old with a missing battery
Examiner: A two-year-old is brought in after a button battery went missing from a remote control. He is well and afebrile, but a shiny metallic disc is wedged against the right side of the nasal septum. He ate 30 minutes ago. Talk me through your immediate thoughts and actions. [3]
Candidate should cover: recognition that a button battery in the nose is a time-critical emergency to be removed immediately, without waiting for a fasting period, because alkaline liquefactive necrosis begins within one to two hours of mucosal contact; the setting decision — theatre and ENT for the uncooperative or embedded case; and the application of topical decongestant and anaesthesia with direct-vision removal. The child's wellbeing does not change the urgency; the object type does. [5]
References8ShowHide
- [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