A teen who had experienced years of nasal congestion along with a mysterious "foul odor" when he blew his nose turned out to have a BB gun pellet lodged in his nose, which had been there for about eight years, according to a new report.
The teen first visited doctors for his symptoms when he was 15 years old. He said he had experienced congestion for several years along with a reduced sense of smell, according to the report, published Feb. 18 in the journal JAMA Otolaryngology - Head & Neck Surgery.
Doctors examined the inside of the teen's nose with an endoscope, or a flexible tube with a camera at the end; and saw that he had so-called "turbinate hypertrophy," or an enlargement of narrow passageways called turbinates in the nose. This condition can sometimes be caused by seasonal allergies or sinus inflammation, according to Healthline.
Doctors prescribed the teen a nasal spray and antihistamine medication, and told him to come back in four to six weeks.
But the teen did not return until one year later, when he was 16, and he was still experiencing nasal symptoms. But now, when he blew his nose, "a pungent, foul odor filled the room," the authors said.
"The patient reported that he did not feel he had bad breath, but he was embarrassed that every time he blew his nose there was a foul odor," they wrote.
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Doctors then performed a CT scan and saw there was 9-mm spherical structure in his nasal cavity, which looked like a foreign body. The teen underwent surgery to remove the object, which turned out to be a metallic BB pellet.
A talk with the teen's family revealed that he had been shot in the nose with a pellet gun when he was about 8 or 9 years old, the report said. At the time, the boy hadn't experienced symptoms, and so his parents had not sought medical care.
Foreign objects lodged in the nose can sometimes cause a foul odor because "the foreign body causes blockage of natural drainage pathways in the nose, so there is a buildup of mucus, inhaled debris and bacteria," study co-author Dylan Z. Erwin, a medical student at The University of Texas Health Science Center at San Antonio, told Live Science.
But this buildup doesn't always trigger a fever or other signs of a whole-body infection, and so the diagnosis can be missed, Erwin said.
In addition, the pellet in the boy's case was even harder to spot because over time, it had become covered with new tissue. "Healthy-appearing tissue had completely grown over it," Erwin said. For doctors to even see the pellet, this surrounding tissue had to be surgically removed, he said.
"It had become lodged in the floor of the nose beneath a structure called the inferior turbinate. It was essentially so tightly wedged, that blowing the nose didn't remove it and it was too far back to be easily seen," Erwin added.
Pellet gun injuries are common in adolescents, but the current case was unique because the injury happened so long ago, and the boy did not have symptoms of nasal trauma, the report said.
When a foreign body is stuck in the nose for a long period of time, doctors worry about a number of complications, including the development of an infection that spreads to the jaw or eyes; or the breakdown of nearby bone due to years of inflammation, Erwin said.
In addition, there's also a risk that the patient could inhale the object if it became dislodged from the nose and goes down the back of the throat, he said.
Fortunately, the teen hadn't experienced any of these complications. After his surgery, his nose tissue appeared normal, and the unpleasant odor disappeared, the report said.