Complications
Several risk factors were associated with increased risk for complications (NFB-type, multiple attempts to remove NFB, posterior insertion of NFB and left-side insertion). These risk factors, when presenting, should alert clinicians in their assessment and management of patients with a NFB, and should be considered in the treatment plan regarding preparation for removal. The complications found in our study are presented in table 2. The overall complication rate was 5%, which concurs with other reports8,11,13. The loss of NFB during a failed attempt can potentially compromise the airway. In 11 (2%) of our patients, the objects were ingested following a failed attempt. Among these, eight occurred after attempts by primary pediatricians, and three after attempts by an otolaryngologist. None of these patients exhibited signs of dyspnea or dysphagia, suggesting that none of the children had aspirated the NFB.
Nasal insertion of batteries and magnets poses a particularly high risk. In our cohort, perforation or significant mucosal lacerations occurred in 13 (2.2%) patients, among whom nine were a direct result of batteries and magnets. The risks for nasal perforation in children who inserted magnets and batteries were extremely high (OR=22 and OR=8.4, respectively, p<0.001). Mucosal necrosis was observed almost entirely in patients with nasal batteries (OR=38, p<0.001). All children who inserted nasal batteries or magnets were treated with systemic antibiotics, on admission or discharge, compared to those who inserted all other materials (OR=7.9, p<0.05). One patient exhibited necrosis of the middle turbinate within 3 hours after the insertion of a button battery. Two patients underwent surgical debridement one month after the incident and one patient had intermittent epistaxis due to septal perforation and had to undergo septo-rhinoplasty surgery years later. The overall risk for complications was significantly higher among patients with inserted batteries or magnets than with all other materials (organic and nonorganic), OR=12.3, p<0.001. This is consistent with previous studies21-22. Small magnets are most commonly found in the nasal cavity of female teenagers, as they are usually a part of jewelry hinged to the ala nasi. Damage to the nose can result from decubitus, leading to ulcers and perforations23. Button batteries have positively and negatively charged poles, on either side. When a negatively charged pole adheres to the nasal septum, the chemical reaction that results in electrolysis can cause rapid septal perforation in up to 4 hours24-25. To this date, follow-up publications that assess long-term nasal damage are lacking.