Button Magnets in the Nasal Cavity: A Pediatric Radiology Case of Septal Compression and Urgent Removal
A radiographic diagnosis with time-sensitive consequences
Executive Answer
Two small, disk-shaped metallic objects seen at the same level on opposite sides of the nasal septum in a child with epistaxis and severe nasal pain should raise immediate concern for paired magnets. When magnets attract across the septum, sustained pressure can injure the mucosa and perichondrium, leading to cartilage exposure, necrosis, and septal perforation. This is an urgent otolaryngologic problem: prompt removal and careful assessment of septal injury are essential.
Clinical Scenario
An 11-year-old boy presented to the emergency department approximately six hours after inserting button magnets into both nostrils. He was unable to remove them and reported severe nasal pain and epistaxis.
Nasal examination showed mucus and crusted blood. Facial radiographs demonstrated two disk-shaped foreign bodies at the same level, positioned across the nasal septum. The initial emergency department removal attempt was unsuccessful because of the strong magnetic attraction.
The patient was taken to the operating room for removal under general anesthesia. Magnets placed externally on both sides of the nose were used to lift the intranasal magnets away from the septum. The procedure revealed compression of the septal cartilage and perichondrial erosion. An adhesion barrier was placed over the injured tissue, and nasal splints were maintained for 10 days. At six-month follow-up, the previously exposed cartilage was covered by healthy nasal mucosa.
Imaging Findings
Plain Radiography: Recognizing the Paired-Magnet Pattern
The supplied case includes two facial radiographic views:
Waters view: Two disk-shaped radiopaque objects are seen at approximately the same craniocaudal level, on opposite sides of the nasal septum.
Lateral view: The objects project over the nasal cavity, supporting their intranasal location.
The key diagnostic clue is not simply that the objects are metallic. It is their paired configuration across the septum in a child with acute pain and bleeding. This pattern is highly concerning for magnets attracting each other through the intervening septal tissue.
Plain radiographs can establish the presence, approximate location, number, and configuration of radiopaque foreign bodies. They may not fully characterize mucosal injury or the precise relationship of the objects to adjacent soft tissues. Clinical examination and direct visualization remain important.
FIGURE 1. Waters view
Waters view showing paired nasal magnets across the septum in an 11-year-old boy
FIGURE 2. Lateral view
Lateral facial radiograph showing disk-shaped foreign bodies in the nasal cavity
Why Paired Nasal Magnets Are an Emergency
Unlike a freely mobile, single nasal foreign body, two magnets in opposing nasal cavities can clamp the septum between them. The magnetic force creates sustained pressure on the mucosa and perichondrium.
The potential sequence of injury is:
Opposing magnets compress the septal soft tissues.
Local perfusion is compromised.
Mucosal and perichondrial injury develops.
Cartilage may become exposed or undergo necrosis.
Healing may result in adhesions, deformity, or septal perforation.
The severity of injury depends on factors such as magnetic strength, contact pressure, duration, and tissue condition. A child may initially have pain and epistaxis before a perforation is clinically apparent. Therefore, the absence of an obvious perforation at presentation does not exclude significant septal damage.
Published case reports and case series describe nasal ulceration, pressure injury, and septal perforation associated with magnets placed on opposite sides of the septum. These reports support urgent removal rather than observation. [1–3]
Radiologist’s Reasoning
The Diagnostic Question
When a child presents with nasal pain, bleeding, and radiopaque objects in the nasal cavity, the radiologist should determine:
How many foreign bodies are present?
Are they in one nasal cavity or on opposite sides of the septum?
Are the objects aligned at the same level?
Does their configuration suggest magnetic attraction?
Is there an associated complication that can be assessed on the available images?
In this case, the two same-level disk-shaped objects across the septum strongly support paired intranasal magnets.
Differential Diagnosis
| Diagnosis | Imaging or clinical clue | Distinguishing consideration |
|---|---|---|
| Paired magnets | Two similar disk-shaped radiopaque objects across the septum | Strong magnetic attraction can compress intervening tissue |
| Button battery | Usually a single disk-shaped object; may show a characteristic double-rim or step-off appearance depending on projection | A battery is also an urgent foreign body, but its appearance and mechanism of injury differ |
| Coin or other metallic object | Usually a single object with a recognizable shape | Does not explain two matching objects attracting across the septum |
| Nasal fracture | May show traumatic bony abnormality | Does not account for paired intranasal disk-shaped foreign bodies |
| Nasal polyp | Soft-tissue opacity rather than metallic radiopacity | Does not explain the acute foreign-body pattern |
A critical safety point is that button batteries and paired magnets are both urgent nasal foreign bodies, but for different reasons. A battery can cause electrochemical tissue injury; paired magnets cause sustained compressive injury. Neither should be treated as a routine, nonurgent nasal foreign body.
Management and Procedural Lessons
The initial emergency department attempt in this case failed because the magnets were strongly attracted to one another. The patient therefore underwent removal in the operating room under general anesthesia.
The successful technique used external magnets placed on both sides of the nose to lift the intranasal magnets away from the septum. The procedure also allowed direct assessment of the injury: septal cartilage compression and perichondrial erosion were identified. An adhesion barrier and temporary splinting were used, followed by clinical surveillance.
This is a case-specific technique, not a universal recommendation for unsupervised or routine bedside removal. Removal strategy should be selected by experienced clinicians according to object position, patient cooperation, tissue injury, available equipment, and local otolaryngology practice. Repeated unsuccessful attempts may worsen trauma or delay definitive care. Pediatric emergency guidance recommends urgent specialist involvement for paired nasal magnets and escalation when an initial removal attempt fails. [4,5]
Diagnostic Risk and Workflow Implications
What Can Be Missed?
The principal diagnostic risk is underestimating the urgency because the radiograph appears to show only small foreign bodies. The objects’ size does not reflect the force exerted on the septum.
Potential workflow vulnerabilities include:
Reporting the presence of foreign bodies without identifying the paired-magnet configuration.
Failing to communicate the risk of septal compression.
Treating the case like a routine, easily removable nasal object.
Repeating removal attempts despite resistance or increasing pain.
Failing to inspect the septum after removal.
A useful radiology impression should state the suspected paired magnets, their relationship across the septum, and the need for urgent clinical removal and otolaryngology assessment.
Could AI Help?
An imaging AI system might eventually flag paired radiopaque objects or support foreign-body detection on facial radiographs. However, this case illustrates why detection alone is insufficient.
A useful system would need to recognize spatial relationships, not merely identify a metallic object. It would also need to communicate the clinical significance of opposing magnets and avoid confusing them with other disk-shaped objects.
Potential failure modes include:
False negatives: Small objects, overlapping anatomy, or suboptimal positioning may obscure one magnet.
False positives: Other metallic objects may trigger an alert.
Anatomical mislocalization: A model may detect two objects but fail to recognize that they lie on opposite sides of the septum.
Automation bias: Clinicians may overlook the urgent configuration if an AI system does not flag it.
AI should therefore be considered a possible adjunct to image interpretation and workflow prioritization—not a substitute for radiologist review, clinical examination, or specialist judgment.
Practical Radiology Pearls
Two similar disk-shaped objects at the same level on opposite sides of the nasal septum should prompt suspicion for paired magnets.
Severe pain and epistaxis are important clinical clues to pressure injury.
The absence of visible septal perforation on initial examination does not exclude evolving tissue damage.
Distinguish paired magnets from a button battery because their mechanisms of injury differ, although both require urgent attention.
Describe the number, shape, location, and relationship of foreign bodies—not just their presence.
Communicate the suspected magnetic configuration directly to the treating team.
If initial removal fails, escalate promptly rather than continuing repeated traumatic attempts.
After removal, assess the septum for mucosal injury, cartilage exposure, and other complications.
Frequently Asked Questions
Why are magnets in both nostrils dangerous?
The magnets may attract across the nasal septum and compress the intervening mucosa and perichondrium. This can impair tissue perfusion and lead to ulceration, cartilage injury, or septal perforation.
What is the key radiographic finding?
Two similar disk-shaped radiopaque objects at approximately the same level on opposite sides of the nasal septum, particularly in a child with pain or epistaxis.
Are paired nasal magnets more urgent than an ordinary nasal foreign body?
Yes. Paired magnets can exert continuous pressure on the septum and cause progressive tissue injury. They require urgent removal and specialist assessment.
Can a nasal magnet be removed at home?
No. Attempts at home can worsen injury, push an object farther into the nose, or delay definitive care. Suspected paired nasal magnets require urgent medical evaluation.
Is CT routinely required?
Not necessarily. In this case, plain radiographs demonstrated the paired foreign bodies and their configuration. Additional imaging should be based on clinical findings, uncertainty about location, suspected complications, and specialist judgment—not ordered automatically.
Can the septum heal after magnet removal?
Healing depends on the extent of injury. In this case, healthy mucosa covered the previously exposed cartilage at six months. Other published cases have developed septal perforation, so follow-up is important.
What should the radiology report emphasize?
The report should identify the number and location of the objects, describe their relationship across the septum, state concern for paired magnets when appropriate, and communicate the need for urgent removal and otolaryngology assessment.
Key Takeaways
Paired magnets in opposite nasal cavities are a time-sensitive foreign-body emergency.
The same-level, opposing disk-shaped radiographic pattern is a critical diagnostic clue.
Sustained septal compression can cause mucosal necrosis, cartilage exposure, and perforation.
Prompt specialist-led removal and post-removal assessment are central to care.
AI may help detect objects, but clinical interpretation and urgent communication remain essential.
Continue Learning:
References
Karkos PD, Karagama YG, Manivasagam A, El Badawey MR. Magnetic nasal foreign bodies: a result of fashion mania. Int J Pediatr Otorhinolaryngol. 2003;67(12):1343–1345. doi:10.1016/j.ijporl.2003.08.044.
Greenberg M, Magit A. Magnetic nasal foreign bodies in a 9-year-old male: opposites attract when it comes to nasal foreign bodies. Int J Pediatr Otorhinolaryngol. 2005;69(7):981–982. doi:10.1016/j.ijporl.2005.02.001.
Shermetaro C, Charnesky M. Pediatric nasal septal perforation secondary to magnet misuse: a case report. Ear Nose Throat J. 2007;86(11):675–676. doi:10.1177/014556130708601119.
Nationwide Children’s Hospital. Intranasal Foreign Body: Emergency Department/Urgent Care Clinical Pathway. Revised April 18, 2024.
Children’s Health Queensland. Foreign body in the nose—Emergency management in children. Queensland Paediatric Emergency Care guideline.
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