Button Batteries in Children’s Noses: Large Case Series Reveals Injury Patterns and Treatment Outcomes

When a small child inserts a coin-sized lithium cell into a nostril, the clock starts ticking on a potentially serious injury. A retrospective cohort study now published in BMC Pediatrics by otorhinolaryngologists at Shenyang Children’s Hospital in China has analyzed 57 pediatric cases of nasal button battery impaction treated at a single tertiary medical center between January 2017 and June 2026, offering one of the most detailed clinical pictures to date of how these foreign bodies behave in the nasal cavity, how quickly they must be removed, and what follow-up care actually delivers. The findings arrive amid growing international alarm over button battery injuries in children, which have traditionally been framed around the far more catastrophic esophageal impactions but which, as this series makes clear, also inflict meaningful damage inside the nose.

The study team, led by Zhijian Liu with co-authors Zhuo Du, Sining Wang, and corresponding author Lan Wu, reviewed demographic and clinical variables including sex, age, presenting symptoms, cause of impaction, battery location, duration of impaction, treatment modality, treatment outcomes, and associated complications. The cohort comprised 37 boys and 20 girls, with ages ranging from 6 months to 13 years. The peak incidence fell between 2 and 3 years of age, accounting for 40.35 percent of cases, or 23 of the 57 children. That age profile is consistent with the broader developmental pattern of foreign body insertion: toddlers at this stage have the manual dexterity to manipulate small objects but lack the cognitive maturity to understand the danger or to report what they have done.

One of the most striking numbers in the series concerns timing. Most patients, 89.47 percent or 51 children, presented within 10 hours after insertion. This early presentation likely reflects a combination of parental vigilance and the rapid onset of symptoms, since a battery lodged against nasal mucosa quickly produces unilateral obstruction, irritation, and bleeding that parents notice. The authors report that all cases presented with varying degrees of nasal mucosal edema, the swelling that results from the battery’s electrochemical attack on tissue. During removal, 42 children, or 73.68 percent, developed epistaxis, the medical term for nosebleed. Fifteen children, or 26.32 percent, presented with eschar formation, the dark crust that develops over burned tissue, and one child was found to have a nasal septal perforation after removal, a defect in the wall dividing the two nasal passages.

The mechanism behind these injuries is well understood in principle. Button batteries generate an electrical current when their two poles contact moist tissue, completing a circuit through the body’s conductive fluids. This current drives electrolysis, producing hydroxide ions, abbreviated OH in the study’s terminology, at the tissue surface. Hydroxide ions are strongly alkaline and cause liquefactive necrosis, dissolving protein structures and destroying cells in a self-propagating chemical burn that continues even after the battery’s charge would seem too weak to power a device. In the narrow, moist, and richly vascular environment of the nasal cavity, this process can rapidly erode mucosa, damage cartilage, and in severe cases perforate the septum. The nasal septum is particularly vulnerable because its mucoperichondrial covering is thin, and once it is breached the underlying cartilage loses its blood supply and can die, leaving a permanent hole.

Treatment in the series was prompt and largely nonoperative. Most batteries, 63.16 percent or 36 cases, were removed in the emergency department while the child was awake, a notable finding because it suggests that with appropriate technique and cooperation, nasal button batteries can often be extracted without general anesthesia. The remaining cases presumably required operative removal or additional sedation, though the study’s abstract does not detail the breakdown. The authors emphasize that nasal button battery foreign bodies can cause severe injury and therefore require prompt treatment, a conclusion that aligns with international guidance on battery impactions anywhere in the aerodigestive tract, where the standard is removal as quickly as possible, ideally within hours rather than days.

After removal, the team applied a structured aftercare regimen. Nasal saline spray was recommended for 50 patients, topical recombinant growth factor for 49, and systemic antibiotics for 10. The growth factor in question, recombinant human basic fibroblast growth factor, abbreviated rh-bFGF, is a topical agent used in China and elsewhere to accelerate wound healing by stimulating fibroblast proliferation and tissue repair. Its use in nearly all cases reflects the team’s approach to managing the mucosal burns left behind after extraction. Systemic antibiotics in a minority of cases suggest a targeted strategy, reserving antimicrobial therapy for children with signs of infection or extensive tissue damage rather than prescribing them routinely.

Follow-up data provide a sobering view of recovery. Fifty-one patients, or 89.5 percent, attended at least one follow-up visit, with a mean follow-up duration of 9.6 plus or minus 6.0 days. Among these, 8 children, or 15.69 percent, had persistent epistaxis, and 11, or 21.57 percent, had nasal congestion. Nasal endoscopy revealed mucosal edema in 20 cases and nasal adhesions in 2 cases, the latter representing scar bands that form between opposing mucosal surfaces and can obstruct airflow if not addressed. The single patient who developed nasal septal perforation exhibited spontaneous healing, a reassuring outcome given that septal perforations in adults often require surgical repair. The authors note that further research is needed, along with increased public awareness and the establishment of more comprehensive follow-up and care protocols, to reduce the incidence of nasal button battery foreign bodies in children or mitigate the injuries they cause.

The study’s strengths lie in its size and its focus on a specific anatomic site that has received less attention than the esophagus. Most published literature on button battery injuries centers on esophageal impactions, where batteries can erode through the esophageal wall within hours and cause tracheoesophageal fistulas, aortic erosion, and death. Nasal impactions, by contrast, have been treated as less urgent, and this series challenges that complacency by documenting edema in every case, nosebleed in nearly three quarters, and a septal perforation in one child. The authors’ call for comprehensive follow-up protocols is significant because the complications they observed, including adhesions and persistent bleeding, emerged after the battery was already out, meaning that removal alone does not end the clinical episode.

For parents and clinicians, the practical implications are clear. Button batteries should be stored out of reach of children, devices should be secured with screwed battery compartments, and any suspicion that a child has inserted a battery into the nose or mouth should prompt immediate medical evaluation rather than watchful waiting. The Shenyang series shows that most children present quickly, that emergency department removal is often feasible, and that structured aftercare with saline irrigation, topical growth factors, and selective antibiotics can support healing. But it also shows that injury is the rule rather than the exception, with edema universal and bleeding common, and that even a brief impaction can leave lasting damage. As button batteries proliferate in household devices, from remote controls to singing cards to key finders, the pediatric otolaryngology community will need more studies like this one to refine removal techniques, standardize aftercare, and ultimately prevent these injuries from happening at all.

Subject of Research: Pediatrics

Article Title: Diagnosis and treatment of button battery impaction in the nasal cavity in children: analysis of 57 cases

Article References: Liu, Z., Du, Z., Wang, S., & Wu, L. (2026). Diagnosis and treatment of button battery impaction in the nasal cavity in children: analysis of 57 cases. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07767-6

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07767-6

Keywords: button battery, nasal foreign body, pediatrics, otolaryngology, foreign body injury, children, BMC Pediatrics, emergency medicine, Diagnosis, treatment, button, battery