Long-term outcomes following nasal button battery foreign body injuries in children: a 10-year retrospective analysis of 45 patients

Objectives: To delineate long-term symptoms, structural sequelae, and follow-up patterns among children presenting with nasal button battery foreign bodies (BBFB), and to identify gaps in post-removal management. Methods: This retrospective cohort study reviewed all pediatric patients (ages 1-18 years) who were treated for nasal BBFB at a tertiary university medical center between January 2014 and January 2024. Extracted data included patient demographics, clinical presentation, acute endoscopic findings, management details, post-removal treatment recommendations, and long-term outcomes. Injury severity was classified according to the presence of mucosal necrosis and/or nasal septal perforation. Results: Forty-five children (mean age, 3.73 years; 57.8% female) were included. The median impaction duration was 4 h. Nasal discharge (35.6%) and epistaxis (27%) were the most common presenting symptoms. Acute endoscopic evaluation revealed eschar in 44.4%, mucosal edema in 42.2%, and mucosal necrosis in 31%. Early septal perforation was identified in 4.4%. Most batteries were removed by otolaryngologists (78%), and the majority of cases were managed in the emergency department without the need for anesthesia (84.4%). Post-removal treatment varied considerably: saline irrigation (60%), topical mupirocin (51%), systemic antibiotics (8.8%). Follow-up recommendations were absent in 40% of discharge summaries. Only 40% of patients completed long-term follow-up (median duration, 2 months). Among those evaluated, persistent symptoms included nasal discharge (44.4%), obstruction (17%), and epistaxis (12%). Late septal perforation was documented in 18%, representing a fourfold increase from initial evaluation. Conclusions: Nasal BBFB injuries are associated with substantial acute and long term morbidity. Substantial variability in post-removal care and low follow-up rates represent critical gaps in management. Persistent symptoms and progressive structural complications were common, highlighting the need for standardized treatment protocols, mandatory follow-up, and prospective research to optimize long-term outcomes.