Button battery removal from a nasal cavity using a magnetic telescopic pickup tool
A 4-year-old boy presented to the Emergency Department (a major trauma centre in the UK, with a dedicated paediatric ED and 48000 annual paediatric emergency presentations) with a possible foreign body in his right nostril. Earlier that day, one of the parents had noticed that something might be in the nostril after wiping the child’s nose after a minor nosebleed. The parents were unsure what the foreign body was, or how long it had been there.
The nurse at triage noticed something that looked metallic in the right nostril. Our department had recently purchased a magnetic telescopic pick-up tool online for less than £2 (see image) for this eventuality.
The pickup tool was covered with a latex glove, and while the parent cuddled the child to keep them still, the tool was gently inserted into their right nostril. Within one second a click was felt, and the tool was withdrawn from the nostril. On the end of the magnetic tool was a button battery.
Re-examination showed no further foreign objects and some mild inflammation at the entrance of the right nostril.
The patient was reviewed by the ENT team who prescribed an anti-bacterial nasal cream and followed up in outpatient clinic two weeks later. At that point the examination was normal.
The idea to purchase a magnetic pickup tool for the department came from Tim Horeczko’s PEM Playbook article and podcast ‘Foreign bodies in the head and neck‘. In it he writes:
Magnetic pick-up tools – used by mechanics, engineers, and do-it-yourselfers – are inexpensive and readily available in various sizes, shapes, and styles such as a telescoping extender. Look for a small tip diameter (to fit in the ear canal as well as the nose) and a strong “hold” (at least a 3lb hold).
Our tool was 2lbs/0.9kg hold. This was adequate for removal of the button battery.
There is one previous case report of a button battery being removed from the nasal cavity of a three-year-old using a magnet (Alletage et al, 2014). In this case, the team created their own device (the Jacobson extractor) with an earth magnet attached to a 14F nasal trumpet (with a flexible arm) attached to a curette. This method was used after a number of failed attempts with other techniques, including suction removal and a balloon catheter.
There are two other nasal foreign body case reports where a magnet was used (not a button battery). Douglas et al (2002) reported a one-year-old with a ball bearing in the nostril which was referred to ENT due to unsuccessful ED removal and was then successfully removed using a similar tool to the one used in this case report. And Yeh at al (2012) report a 26-year-old with two magnetic disc earrings (one up each nostril) which required two cardiac pacemaker magnets attached to two forceps. One device was used simultaneously in each nostril to separate the earrings.
There are three case reports where magnets were used to remove metallic objects from the ear. Landry et al (1986) used a magnetized screwdriver to remove a button battery from a nine-year-old’s ear; Nivatvongs et al (2015) used a telescopic magnetic rod to remove a button battery from a nine-year-old’s ear under general anaesthetic after multiple failed alternative techniques were attempted in the Emergency Department, and Din et al (2019) reported the use of a specially-designed angled magnetic probe to remove a metal bolt from a ten-year-old’s ear canal.
Our case report is the first where a simple magnetic telescopic pickup tool was used to remove a button battery from the nose as the first attempt resulting in successful and swift removal.
Note: full consent has been obtained from the child’s family for publication
To learn more about foreign body removal check out Becky Platt’s talk and accompanying post from DFTB Essentials.