History: A previously healthy 9 yo M presents to the ED with his mom for evaluation of a battery in his ear x 1hr  

-       He describes the battery as “a flat cylinder” and silver

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Urgent care made one unsuccessful attempt at removal then sent patient to ED

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No difficulty hearing, no headache, no fevers
 

Physical Exam 

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Normal vitals

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R ear: Pinna with no redness or tenderness. Foreign body observed in ear canal, appears to be silver disc. Unable to assess TM because of foreign body. No redness, swelling, drainage, or bleeding. No pain with manipulation of pinna during exam. 

Management

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Attempt made in ED to remove battery with toothed forceps. Able to contact metal surface of battery, however unable to remove battery from ear. When removing forceps from ear, removed black, tarry substance from ear that is notably distinct from patient’s cerumen. 

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Concern for battery corrosion and/or burn to surrounding ear tissue. 

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Emergent ENT consultation in ED. 

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ENT resident removed button battery from ear canal using ear speculum, Frazier suction tip, alligator forceps. 

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After removal, skin of external auditory canal noted to have burn and black discoloration. Tympanic membrane was not fully visible, and perforation could not be ruled out. 

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The patient reported feeling better after removal. He was discharged to home with antibiotic ear drops and follow-up with ENT in 3 days. 
 

Follow up

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At ENT outpatient follow-up, patient found to have perforated TM with debris on edges of tissue, mildly decreased hearing in that ear 
 

Pearls

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Button batteries are often composed of metal anode and metal oxide cathode, immersed in alkali solution and can cause damage by: electrical burn, alkali chemical burn (liquefactive necrosis), or pressure necrosis from being lodged

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Complications of insertion into ear include local skin damage in external auditory canal, TM perforation, hearing loss, malignant otitis externa, facial nerve injury, damage to vestibular labyrinth, and has even been implicated in causing osteomyelitis of the temporal bone. 

Bottom Line 

Button batteries need to be removed emergently to prevent or limit damage to local structures. 

References 

Ettyredd A, George M, Chi D, Gaines B, Simons J. Button Battery Injuries in the Pediatric Aerodigestive Tract. Ear Nose Throat J. 2015; 94(12):486-493. doi:10.1177/014556131509401207 

Hernot S, Yadav S, Kathuria B, Kaintura M. A Rare Complication Due to Button Battery Cell in Ear. Indian Journal of Otology. 2016; 22(1): 52-55. 

Display image, accessed August 25, 2020: https://www.smh.com/news/button-batteries-kids-what-you-need-to-know