Our editor Declan Costello caught up with Professors Fred Dikkers and Tjark Ebels, both at the forefront of the mission for improved safety, to discuss the latest developments of regulation and innovation.
ENT surgeons around the world are aware of the huge damage that can be caused by the ingestion of button batteries. These tiny pieces of metal are visually very appealing to young children, so they frequently swallow them. Nobody in our specialty has done more to improve safety than our friend Prof Fred Dikkers, so it was a pleasure to catch up with him and his collaborator Prof Tjark Ebels to discuss their progress up to this point.
Tjark started by explaining that he and Fred became friends when their children attended elementary school together! They then met at work during an operation on a child who had ingested a button battery, and who had sustained devastating injuries. That first patient was in 2002, and this case was published in The Lancet in 2003.
Fred explained the dangers of button batteries: when they come into contact with saliva, there is immediate oxidation/reduction leading to hydrolysis, producing OH-ions, which have an exceptionally high pH level – up to pH14 within one minute. This is extremely corrosive, leading to rapid soft tissue damage. The batteries can become stuck at the cricopharyngeus, or at the next narrowing of the oesophagus – at the level of the aorta. It is here that an aorto-oesophageal fistula can occur, which is unsurvivable.
Making a button battery safe relies on safe packaging, and also on redesigning the battery by preventing the ions in the saliva producing a current. There are currently two Button Battery Task Forces – an international one and a European one. In the US, the international body has led to ‘Reese’s law’, which mandates safe packaging. In fact, the EU initiated a competition in consumer product safety, and Fred and Tjark’s team won the gold award. They were then able to have a call with the major battery manufacturers, and they have been working with them ever since. Six manufacturers have 80% of the global market, and five of those companies have engaged well with Fred and Tjark.
In the EU, the regulators have said that as soon as their design is mass-producible, they will implement it in European regulations. Globally, this area is regulated by the International Electrotechnical Commission (IEC), who have been looking at this area for some time. The cost of implementing the invention is around an extra 10% on the price of a battery.
This is an area where innovations really are going to save lives, so we will keep you posted as to new developments.
