A Mysterious Odor After Nose Blowing | Olfaction and Taste | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

A Mysterious Odor After Nose Blowing

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A healthy 15-year-old male patient presented with several years of bilateral congestion and hyposmia. He and his family denied facial trauma, recent or recurrent sinusitis, rhinorrhea, difficulty breathing, pain, change in vision, and constitutional symptoms. He had never had allergy testing but did have occasional allergic symptoms, including sneezing and itchy eyes and nose. He did not report any drug, alcohol, or tobacco use. He was developmentally normal. On physical examination, the patient appeared healthy and had a normal-sounding voice. The tonsils were small, without crypts or tonsilloliths, and there were no neck masses.

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

D. Foreign body

The results of the computed tomography scan showed clear sinuses, but a 9-mm spherical structure was noted in the left inferior nasal cavity with surrounding spiculated calcifications and chronic dystrophic calcification, suggestive of an intranasal foreign body.

The patient was taken to the operating room for a bilateral nasal endoscopy, turbinate reduction, and removal of a foreign body from the left nasal cavity. The inferior turbinate was medialized, and there was friable granulation tissue inferomedial to the inferior turbinate. This tissue was gently suctioned, and bleeding was encountered. After continued suctioning and application of a topical decongestant with an oxymetazoline-soaked pledget, a metallic foreign body was visualized (Figure 2). This body was removed and epistaxis was controlled.

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Corresponding Author: Dylan Z. Erwin, BBA, 7342 Oak Manor Dr, #7206, San Antonio, TX 78229 (erwind@livemail.uthscsa.edu).

Published Online: February 18, 2021. doi:10.1001/jamaoto.2020.5628

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Leboulanger  N .  Nasal obstruction in children.   Eur Ann Otorhinolaryngol Head Neck Dis. 2016;133(3):183-186. doi:10.1016/j.anorl.2015.09.011PubMedGoogle ScholarCrossref
2.
Hanna  TN , Shuaib  W , Han  T , Mehta  A , Khosa  F .  Firearms, bullets, and wound ballistics: an imaging primer.   Injury. 2015;46(7):1186-1196. doi:10.1016/j.injury.2015.01.034PubMedGoogle ScholarCrossref
3.
Ford  EG , Senac  MO  Jr , McGrath  N .  It may be more significant than you think: BB air rifle injury to a child’s head.   Pediatr Emerg Care. 1990;6(4):278-279. doi:10.1097/00006565-199012000-00007PubMedGoogle ScholarCrossref
4.
Harkare  VV , Khadakkar  SP , Deosthale  NV , Dhoke  P , Dhote  K .  Endoscopic management of accidentally lodged airgun pellet in paranasal sinus.   People’s Journal of Scientific Research. 2018;11(1):78-81. https://www.pjsr.org/Mar2017C/78-81.pdfGoogle Scholar
5.
Kim  BJ , Shoffel-Havakuk  H , Johns  MM  III .  Retained nasal trumpet for 20 months: an unusual foreign body.   JAMA Otolaryngol Head Neck Surg. 2019;145(1):93-94. doi:10.1001/jamaoto.2018.2939PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close