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Clinical Note |

Battery Ingestion Leading to Bilateral Vocal Cord Paresis

Sapna A. Patel, MD; Allen D. Hillel, MD; Jonathan Perkins, DO
JAMA Otolaryngol Head Neck Surg. 2013;139(3):304-306. doi:10.1001/jamaoto.2013.1825.
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Published online

Importance Disk battery ingestion is common in the pediatric population, with over 50 000 ingestions reported annually. In the upper aerodigestive tract, consequences of such ingestions vary widely from superficial mucosal ulcerations to death from erosion through vital structures. This report describes a battery ingestion complication, vocal cord paralysis, to our knowledge not previously described in the otolaryngology literature.

Observations We describe a patient who presented with biphasic stridor and drooling after upper esophageal disk battery ingestion. The battery was removed 5 hours after ingestion, but stridor with respiratory distress persisted. To stabilize the airway, a tracheotomy was performed after a several-week period of inpatient observation. Two years after ingestion, the patient is tracheostomy dependent.

Conclusions and Relevance Disk battery ingestion has the potential for recurrent laryngeal nerve damage and vocal cord paralysis. Expeditious battery removal and long-term care are crucial for successful ingestion management, as ingestion complications can be significant.

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Figure 1. A 15-month-old boy who swallowed a 2-cm, 3-V lithium ion battery. A, Chest radiograph of a foreign body lodged in the cervical esophagus. The double ring sign is visible. B, Endoscopic view of the battery lodged in the esophagus.

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Figure 2. The patient shown in Figure 1. A, Circumferential tissue injury after removal of the battery. B, Three weeks after battery removal, a partially healed ulcer of the esophagus can be seen.

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Figure 3. Placement of a fine wire electrode in the right thyroarytenoid muscle. Previously placed wires in both posterior cricoarytenoid muscles can be seen.

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