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Management and Outcomes of Button Batteries in the Aerodigestive Tract: A Multi‐institutional Study
Author(s) -
Shaffer Amber D.,
Jacobs Ian N.,
Derkay Craig S.,
Goldstein Nira A.,
Giordano Terri,
Ho Sandra,
Kim Bong J.,
Park Albert H.,
Simons Jeffrey P.
Publication year - 2021
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28568
Subject(s) - medicine , dysphagia , surgery , vomiting , impaction , tracheoesophageal fistula , perforation , odynophagia , retrospective cohort study , rhinorrhea , esophageal stricture , otorhinolaryngology , fistula , metallurgy , materials science , punching
Objectives/Hypothesis To describe the clinical presentation, management, and complications associated with button battery impaction in the aerodigestive tract in children. Study Design Retrospective case series. Methods This multi‐institutional study, endorsed by the American Society of Pediatric Otolaryngology research consortium, is a retrospective medical record review, including all children at five tertiary‐care institutions presenting with button batteries impacted in the aerodigestive tract between January 2002 and December 2014. Battery type/size, duration and location of impaction, presenting symptoms, treatment, complications, and outcomes were examined. Results Eighty‐one patients were included (64.2% male), with ingestion witnessed in 20 (24.7%). Median age at presentation was 3 years (range, 1 week–14 years). Median time from diagnosis to removal was 2.5 hours (range, 0.4–72 hours). Locations included the esophagus (n = 48), hypopharynx (n = 1), stomach (n = 6), nasal cavity (n = 22), and ear canal (n = 4). Most common symptoms for esophageal/hypopharyngeal impactions included dysphagia (26.5%), nausea/vomiting (26.5%), drooling (24.5%), cough (18.4%), and fever (18.4%). Most common symptoms for nasal impactions included epistaxis (54.6%), rhinorrhea (40.9%), nasal pain (27.3%), and fever (22.7%). Almost all esophageal impactions were from 3‐V (89.5%), 20‐mm (81.8%) lithium batteries. Severe esophageal complications included stricture (28.6%), perforation (24.5%), tracheoesophageal fistula formation (8.2%), pneumothorax (4.1%), and bilateral true vocal fold paresis (4.1%). Nasal complications included necrosis (59.1%), septal perforation (27.3%), and saddle nose deformity (4.5%). Duration of impaction correlated with an increased likelihood of persistent symptoms only for nasal batteries ( P = .049). Conclusions Button batteries in the upper pediatric aerodigestive tract or ear canal should be considered a surgical emergency, requiring urgent removal and careful vigilance for complications. Level of Evidence 4 Laryngoscope , 131:E298–E306, 2021