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While it is often ok to defer removal of pesky nasal foreign bodies until ENT follow up, if the foreign body may be a button battery, emergent identification and removal is indicated.
Damage can occur in 3 hours, and by 24 hours, near complete necrosis of turbinates and ala has been described.
- If the object may be a button battery, consider a plain film - if it doesn't show up, it isn't a battery, and you are in the clear.
- If you can clearly see the button battery, you can try to remove it - consider using a magnet if one is available - more on that in a future pearl.
- Lastly, if you cannot visualize the battery, if there is any evidence of content leakage, or if there is any tissue damage, emergently consult ENT for assistance - this is a surgical emergency.
References
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Dane S, Smally AJ, Peredy TR. A Truly Emergent Problem: Button Battery in the Nose. Academic Emergency Medicine. 2000; 7:204-206
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Glynn F, Amin M, Kinsella J. Nasal Foreign Bodies in Children: Should They Have a Plain Radiograph in the Accident and Emergency? Pediatric Emergency Care. 2004;24:217-218.