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. 2023 Apr;43(2):149-154.
doi: 10.14639/0392-100X-N2083.

Mechanism of ear canal button battery injury and strategies for mitigation of damage

Gökhan Akgül  1 , Mehmet Eser Sancaktar  2 , Doğukan Özdemir  3 , Mehmet Dursun Mehel  1 , Nesrettin Fatih Turgut  1 , Ayşe Çeçen  3
Affiliations

Mechanism of ear canal button battery injury and strategies for mitigation of damage

Gökhan Akgül et al. Acta Otorhinolaryngol Ital. 2023 Apr.

Abstract
in English, Italian

Objectives: In this study, the damage caused by button batteries (BB) trapped in the ear canal (EC) and strategies to reduce this damage before their removal were investigated in vitro.

Methods: After four EC models prepared from freshly frozen cadaveric bovine ears were thawed, 3 V lithium BBs were placed in the channels. After a three-hour period of preliminary damage, nothing was applied to the first EC model, the second EC model underwent saline administration, the third EC model underwent boric acid administration, and the fourth EC model underwent the administration of 3% acetic acid. The voltage, tissue temperature, and pH of the BBs were measured. The BBs were removed at the end of the 24th hour, and the EC models were examined by a pathologist.

Results: The greatest decrease in pH was detected in the fourth EC model in which acetic acid was administered. The depth of necrosis was 854 µm in the first EC model, 1858 µm in the second EC model, and 639 µm in the third EC model at the end of the 24th hour. No necrosis was detected in the fourth EC model.

Conclusions: Lithium BBs can cause alkaline tissue damage in a short time in cadaveric EC models. pH neutralisation strategies appear to be experimentally successful under in vitro conditions.

Meccanismo di lesione della batteria a bottone del condotto uditivo e sperimentazione di strategie di riduzione del danno.

Obiettivi: In questo studio, sono stati studiati in vitro i danni causati dalle batterie a bottone (BB) intrappolate nel condotto uditivo (EC) e le strategie per ridurre questo danno nel periodo di tempo intercorrente fino alla loro rimozione.

Metodi: Dopo che 4 modelli EC preparati da orecchi di cadavere bovino appena congelati sono stati scongelati, sono stati collocati BB al litio da 3 V nel canale. Dopo 3 ore di danno preliminare, non è stato applicato nulla al 1° modello EC, il 2° modello EC è stato sottoposto a somministrazione di soluzione salina, il 3° modello EC è stato sottoposto a somministrazione di acido borico, il 4° modello EC è stato sottoposto ad acido acetico al 3%. Sono stati misurati il voltaggio, le temperature dei tessuti e il pH dei BB. I modelli EC sono stati esaminati da un patologo.

Risultati: La maggiore diminuzione del pH è stata rilevata nel 4° modello EC in cui è stato somministrato acido acetico. Mentre la maggiore profondità di necrosi è stata osservata nel 2° modello EC, non è stata osservata necrosi nel 4° modello EC.

Conclusioni: Le BB al litio possono causare danni ai tessuti alcalini in breve tempo nei modelli EC da cadavere. Le strategie di neutralizzazione del pH sembrano avere successo sperimentalmente in condizioni in vitro.

Keywords: Button battery; alkali necrosis; aural foreign bodies; mitigation strategy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Placement of a 3 V lithium BB in the EC and reaction steps of BB by applying saline (h, hour).
Figure 2.
Figure 2.
Images of changes at 6, 12, and 24 h. (A) Lithium BB, (B) Lithium BB + saline, (C): Lithium BB + boric acid, (D) Lithium BB+ acetic acid.
Figure 3.
Figure 3.
(A) pH, (B) voltage, (C) temperature, change of ambient data of BB over time.
Figure 4.
Figure 4.
Pathological images after 24 hours. (A) Lithium BB, (B) Lithium BB + saline, (C) Lithium BB + boric acid, (D) Lithium BB + acetic acid. Depth of necrosis A: 1612 μm, B: 1858 μm, C: 723 μm, D: no necrosis. (×40 magnification; H&E paint; Olympus light microscope shot using DP2 program, Olympus Corp. Shinjuku, Tokyo, Japan).
See this image and copyright information in PMC

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