Skip to main content
SpringerLink
Log in

Vocal cord paralysis following lithium button battery ingestion in children

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

This study reports on vocal cord paralysis caused by esophageal button battery (BB) ingestion in children. Medical records of children with vocal cord paralysis and esophageal BB ingestion treated at a tertiary referral institute between January 2016 and March 2020 were reviewed. Five patients aged 9–58 months were identified; three were male. Each patient had accidentally swallowed a 20-mm-diameter lithium battery (3 CR2032 type and 2 CR2025 type). One battery was removed within 4 h after ingestion, and three batteries were removed within 12 h. Removal of the battery was achieved with rigid esophagoscopy in four patients and direct laryngoscopy in one patient. Four patients had bilateral, and one had unilateral vocal cord paralysis. Three patients underwent tracheotomy; two were tracheotomy-dependent until follow-up, while the third patient died of multiple organ dysfunction syndrome a month after surgery. The two cases without tracheotomy remain under close follow-up.

Conclusion: Accidentally ingested button batteries should be removed promptly to avoid severe complications. Respiratory support and neurotrophic treatment in the early stage of vocal cord paralysis may be beneficial for recovery of vocal cord movement.

What is Known:

• Button battery ingestion in children is extremely harmful, especially when the diameter of the button battery exceeds 20 mm.

• Esophageal button battery impaction can cause serious complications such as esophageal perforation, mediastinal infection, tracheoesophageal fistula, vocal cord paralysis, and life-threatening bleeding.

What is New:

• Vocal cord paralysis in children with button battery ingestion plays an early warning role for identifying the severity of the disease.

• Early neurotrophic drugs and glucocorticoid therapy may be helpful for the recovery of vocal cord movement, thereby avoiding tracheotomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

BB:

Button battery

M:

Male

MODS:

Multiple organ dysfunction syndrome

F:

Female

References

  1. Krom H, Visser M, Hulst JM, Wolters VM, van den Neucker AM, de Meij T, van der Doef HPJ, Norbruis OF, Benninga MA, Smit MJM, Kindermann A (2018) Serious complications after button battery ingestion in children. Eur J Pediatr 177:1063–1070. https://doi.org/10.1007/s00431-018-3154-6

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lahmar J, Celerier C, Garabedian EN, Couloigner V, Leboulanger N, Denoyelle F (2018) Esophageal lesions following button-battery ingestion in children: analysis of causes and proposals for preventive measures. Eur Ann Otorhinolaryngol Head Neck Dis 135:91–94. https://doi.org/10.1016/j.anorl.2017.09.004

    Article  CAS  PubMed  Google Scholar 

  3. Laulicht B, Traverso G, Deshpande V, Langer R, Karp JM (2014) Simple battery armor to protect against gastrointestinal injury from accidental ingestion. Proc Natl Acad Sci U S A 111:16490–16495. https://doi.org/10.1073/pnas.1418423111

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Orsagh-Yent D, McAdams RJ, Roberts KJ, McKenzie LB (2019) Foreign-body ingestions of young children treated in US emergency departments: 1995–2015. Pediatrics 143(5):e20181988. https://doi.org/10.1542/peds.2018-1988

    Article  Google Scholar 

  5. Litovitz T, Whitaker N, Clark L, White NC, Marsolek M (2010) Emerging battery-ingestion hazard: clinical implications. Pediatrics 125:1168–1177. https://doi.org/10.1542/peds.2009-3037

    Article  PubMed  Google Scholar 

  6. Patel SA, Hillel AD, Perkins J (2013) Battery ingestion leading to bilateral vocal cord paresis. J Am Med Assoc Otolaryngol Head Neck Surg 139:304–306. https://doi.org/10.1001/jamaoto.2013.1825

    Article  Google Scholar 

  7. Lerner DG, Brumbaugh D, Lightdale JR, Jatana KR, Jacobs IN, Mamula P (2020) Mitigating risks of swallowed button batteries: new strategies before and after removal. J Pediatr Gastroenterol Nutr 70:542–546. https://doi.org/10.1097/MPG.0000000000002649

    Article  PubMed  Google Scholar 

  8. Thomson M, Sharma S (2015) The hazards of button battery ingestion. Arch Dis Child 100:1010–1011. https://doi.org/10.1136/archdischild-2015-308313

    Article  PubMed  Google Scholar 

  9. Bolton SM, Saker M, Bass LM (2018) Button battery and magnet ingestions in the pediatric patient. Curr Opin Pediatr 30:653–659. https://doi.org/10.1097/MOP.0000000000000665

    Article  PubMed  Google Scholar 

  10. Varga A, Kovacs T, Saxena AK (2018) Analysis of complications after button battery ingestion in children. Pediatr Emerg Care 34:443–446. https://doi.org/10.1097/pec.0000000000001413

    Article  PubMed  Google Scholar 

  11. Leinwand K, Brumbaugh DE, Kramer RE (2015) Button battery ingestion in children: a paradigm for management of severe pediatric foreign body ingestions. Gastrointest Endosc Clin N Am 26(1):99–118. https://doi.org/10.1016/j.giec.2015.08.003

    Article  Google Scholar 

  12. Kramer RE, Lerner DG, Lin T, Manfredi M, Shah M, Stephen TC, Gibbons TE, Pall H, Sahn B, McOmber M, Zacur G, Friedlander J, Quiros AJ, Fishman DS, Mamula P, North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Endoscopy Committee (2015) Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr 60(2015):562–574. https://doi.org/10.1097/mpg.0000000000000729

    Article  PubMed  Google Scholar 

  13. Volker J, Volker C, Schendzielorz P, Schraven SP, Radeloff A, Mlynski R, Hagen R, Kristen R (2017) Pathophysiology of esophageal impairment due to button battery ingestion. Int J Pediatr Otorhinolaryngol 100:77–85. https://doi.org/10.1016/j.ijporl.2017.06.030

    Article  PubMed  Google Scholar 

  14. Semple T, Calder AD, Ramaswamy M, McHugh K (2018) Button battery ingestion in children-a potentially catastrophic event of which all radiologists must be aware. Br J Radiol 91:20160781. https://doi.org/10.1259/bjr.20160781

    Article  PubMed  Google Scholar 

  15. Jatana KR, Rhoades K, Milkovich S, Jacobs IN (2017) Basic mechanism of button battery ingestion injuries and novel mitigation strategies after diagnosis and removal. Laryngoscope 127:1276–1282. https://doi.org/10.1002/lary.26362

    Article  CAS  PubMed  Google Scholar 

  16. Hoagland MA, Ing RJ, Jatana KR, Jacobs IN, Chatterjee D (2020) Anesthetic implications of the new guidelines for button battery ingestion in children. Anesth Analg 130:665–672. https://doi.org/10.1213/ANE.0000000000004029

    Article  PubMed  Google Scholar 

  17. Cairns R, Brown JA, Lachireddy K, Wylie C, Robinson J, Dawson AH, Buckley NA (2019) Button battery exposures in Australian children: a prospective observational study highlighting the role of poisons information centres. Clin Toxicol (Phila) 57:404–410. https://doi.org/10.1080/15563650.2018.1537492

    Article  CAS  Google Scholar 

  18. Eliason MJ, Ricca RL, Gallagher TQ (2017) Button battery ingestion in children. Curr Opin Otolaryngol Head Neck Surg 25:520–526. https://doi.org/10.1097/moo.0000000000000410

    Article  PubMed  Google Scholar 

  19. Kurowski JA, Kay M (2017) Caustic ingestions and foreign bodies ingestions in pediatric patients. Pediatr Clin N Am 64:507–524. https://doi.org/10.1016/j.pcl.2017.01.004

    Article  Google Scholar 

  20. Thatcher A, DiPaola F, Zopf D (2017) Complication of button battery ingestion. Gastroenterol 153:e10–e11. https://doi.org/10.1053/j.gastro.2017.03.061

    Article  Google Scholar 

  21. Arnold M, Numanoglu A (2017) Caustic ingestion in children: a review. Semin Pediatr Surg 26:95–104. https://doi.org/10.1053/j.sempedsurg.2017.02.002

    Article  PubMed  Google Scholar 

  22. Bernstein JM, Burrows SA, Saunders MW (2007) Lodged oesophageal button battery masquerading as a coin: an unusual cause of bilateral vocal cord paralysis. Emerg Med J 24:e15

    Article  Google Scholar 

  23. Dall’Oglio L, Caldaro T, Foschia F, Faraci S, Federici di Abriola G, Rea F, Romeo E, Torroni F, Angeline G, Angelis D (2016) Endoscopic management of esophageal stenosis in children: new and traditional treatments. World J Gastrointest Endosc 8:212–219. https://doi.org/10.4253/wjge.v8.i4.212

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The families of the children whose images are contained within this study gave consent for their inclusion.

Funding

Beijing Hospitals Authority’ Ascent Plan: DFL20191201.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology Head and Neck Surgery, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, China

    Qingchuan Duan, Fengzhen Zhang, Guixiang Wang, Hua Wang, Hongbin Li, Jing Zhao, Jie Zhang & Xin Ni

Authors
  1. Qingchuan Duan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fengzhen Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guixiang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hua Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hongbin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jing Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jie Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xin Ni
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Qingchuan Duan, MD, contributed to acquisition of data, analysis and interpretation of data, drafting the manuscript, and approved the version of the manuscript to be published. Fengzhen Zhang, MD, contributed to acquisition of data, analysis of data and approved the version of the manuscript to be published. Guixiang Wang, MD, contributed to acquisition of data and approved the version of the manuscript to be published. Hua Wang, MD, contributed to acquisition of data and approved the version of the manuscript to be published. Hongbin Li, MD, contributed to acquisition of data and approved the version of the manuscript to be published. Jing Zhao, MD, contributed to acquisition of data and approved the version of the manuscript to be published. Jie Zhang, MD, contributed to the conception and design of study, contributed to acquisition of data, analysis and interpretation of data, critically. Xin Ni, MD, contributed to the conception and design of study.

Corresponding author

Correspondence to Jie Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Peter de Winter

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Duan, Q., Zhang, F., Wang, G. et al. Vocal cord paralysis following lithium button battery ingestion in children. Eur J Pediatr 180, 1059–1066 (2021). https://doi.org/10.1007/s00431-020-03830-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-020-03830-1

Keywords

Search

Navigation