Best of five
- A. Oral antibiotics and review tomorrow
- B. Irrigate the nose
- C. Immediate removal under the safest available controlled conditions
- D. Wait for spontaneous passage
- E. Routine elective theatre list
FRCS (ORL-HNS) · SECTION 1 SBA
Nasal button battery
A 3-year-old has unilateral offensive discharge; a button battery is visible against the septum and removal in clinic has failed. What is the best next step?
C. Immediate removal under the safest available controlled conditions
Button batteries cause rapid liquefaction necrosis and electrical injury; failed simple removal requires urgent escalation, not delay.
Why every option is right or wrong
A. Oral antibiotics and review tomorrow: Medication does not stop ongoing electrochemical injury.
B. Irrigate the nose: Irrigation may increase leakage and tissue exposure.
C. Immediate removal under the safest available controlled conditions: Button batteries cause rapid liquefaction necrosis and electrical injury; failed simple removal requires urgent escalation, not delay.
D. Wait for spontaneous passage: A nasal battery is impacted and can destroy septal cartilage.
E. Routine elective theatre list: The urgency is measured in hours, not weeks.
What if the scenario changed?
If the object were an inert bead without airway risk or tissue injury, removal could be planned less urgently according to cooperation and local expertise.
Independent Clinora preparation material; not official JCIE content, an accredited programme or a substitute for local policy and specialist judgement.
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