Button Battery Leak in the Ear: Severe Chemical Burns, Hearing Loss, and Emergency Response

A button (coin) cell battery lodged in the ear canal that leaks electrolyte (typically sodium/potassium hydroxide) causes rapid, severe alkaline chemical injury.

Immediate Dangers

• Liquefaction necrosis: Hydroxide ions saponify fats, denature proteins → deep tissue destruction.
• External auditory canal: Full-thickness burns, stenosis.
• Tympanic membrane: Perforation, medial displacement.
• Middle ear: Ossicular erosion, facial nerve injury, labyrinthine fistula → sensorineural hearing loss, vertigo.
• Systemic absorption: Rare but possible metabolic alkalosis, hemolysis.

Emergency Protocol

1. Do NOT attempt removal—may push battery deeper or spread alkali.
2. Call ENT / proceed to ED immediately.
3. Irrigate with copious normal saline or water if trained and delay >15 min (controversial; some advise against to avoid spreading).
4. Microscopic/endoscopic removal by otolaryngologist under visualization.
5. Topical antibiotics/steroids post-removal; systemic if extensive.
6. Audiometric and vestibular follow-up.

Time is tissue: irreversible damage occurs within 1–2 hours.