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.