Bullet fragment in the eustachian tube presenting as conductive hearing loss and lead toxicity

Foreign bodies in the Eustachian tube are rare clinical entities, as are cases of lead toxicity associated with retained ballistic fragments. We report a case of a 33-year-old woman with a retained bullet fragment within the Eustachian tube, leading to a chronic middle ear effusion and conductive hearing loss. Symptoms of lead toxicity were also reported on presentation and elevated blood lead level was confirmed with testing. The patient underwent trans-nasal endoscopic removal of the bullet fragment. Subsequently the Eustachian tube function returned to normal, the hearing loss was resolved, and lead toxicity improved.