A young teen boy’s years of nasal congestion and other bizarre symptoms had an unusual culprit. His doctors say that the boy unknowingly had a BB gun pellet lodged in his nasal cavity for nearly a decade, which eventually caused him to give off an awful odor every time he blew his nose. Fortunately, they were able to surgically remove the foul offender, and the boy recovered completely with no complications, smelliness included.
The strange case was detailed in a report published last month in JAMA Otolaryngology–Head and Neck Surgery.
According to the report, the then 15-year-old boy had visited doctors in San Antonio after years of experiencing nasal congestion on both sides of the nose, along with a reduced sense of smell. At the time, his family couldn’t think of any past injuries or underlying medical conditions that would explain the symptoms, and the boy seemed otherwise healthy. The only physical sign of something being wrong was evidence of enlarged turbinates — narrow structures in the nose that help regulate airflow — which can be caused by mundane problems like seasonal allergies. He was prescribed a steroid nasal spray along with antihistamines and asked to return to the clinic a month later.
The boy did return but not until a year later. His earlier symptoms had remained unchanged, and a new problem had cropped up. Whenever he blew his nose now, “a pungent, foul odor filled the room,” the doctors wrote. And while the boy was confident that he didn’t have bad breath, he was understandably embarrassed about his condition.
The doctors then performed a CT scan of his nose, and noticed a 0.4-inch-long (9-millimetre-long) ball-like structure along the boy’s left nasal cavity. The structure was also surrounded by tissue, meaning that his body had started to grow around it. The doctors soon suspected that a foreign body had somehow ended up inside his nose, and they moved to surgically remove it. Once they did, they discovered the metallic BB pellet.
When the doctors talked with the boy and his family after the surgery, he remembered being struck in the nose by a BB gun sometime around the age of 8 or 9 years old. Since he seemed fine afterward, though, his parents decided not to seek any further medical attention. To be fair, the boy’s situation was unusual. Pellet gun injuries are pretty common, especially among younger people. A 2019 study found that on average, 14,000 children reported pellet gun injuries per year between 1990 and 2016. But getting a pellet stuck in your nose without any outward sign of physical trauma and only noticing years later certainly made the boy’s case unique, doctors wrote.
“Nontraumatic nasal pellet inhalation appears to be extremely rare in adolescents with no history of trauma,” they wrote.
As for how the flesh-covered pellet eventually made him smell bad, the doctors suspect that it had started to clog up drainage pipes in the nasal cavity that carry away mucus, bacteria and other assorted junk inhaled into the nose, LiveScience reported. Given enough time, the pellet might have been even worse for the boy, since it could have helped cause a serious infection or inflammation that would damage surrounding bone and tissue. The metal found in the pellet could have also slowly poisoned him, or it could have dislodged and gotten stuck in his throat.
Thankfully, the surgery went off without a hitch. And the boy’s first follow-up visit post-surgery showed that his nose had fully healed up, along with a complete lack of nostril-related funk. Given the happy ending, the authors hope their report will serve as a helpful guide for doctors who encounter similar cases.
“Patients with a history of recurrent rhinorrhea, congestion, and putrid nasal discharge or odor warrant careful examination for foreign bodies, regardless of age or history,” they wrote.