Bad smell from mouth and nose

How many times you have come across a person sitting next to you emanating bad smell while talking? I was amazed to find number of persons or the partners complaining of bad smell from mouth. Old habit of thorough gargling after eating is gradually vanishing due to parties and eating outside. Gargles are replaced by Mint chocolates, peppermints or chewing gums.

There are 3 types of such smell:

* Person and the opposite person both get the smell

The origin of such smell can be from nose, sinuses, mouth, throat, stomach or lungs. Cold with or without yellowish nasal discharge due to sinus infection, mouth ulcers, constipation, infective diarrhea give smelly stool and mouth, lung disease like enlargement of end of windpipe (Bronchiectasis) and thereby collecting cough in those enlarged end, cancer of mouth, food pipe or windpipe can give rise to bad smell. Certain ulcers of the mouth and throat (Vincent’s) give rise to fishy smell.

* Person does not get the smell. Only the opposite person gets the smell

This is a pitiable condition. The lining of the nose becomes dry and loses hair and secretary glands. Such condition occurs in patients of long standing sinus infection, Syphilis, TB, Leprosy of nose, severe anaemia with deficiency in protein. Nasal partition (Septum) is markedly bent on one side that causes excessive roominess of one nostril and drying of one side of nose. Condition is called Atrophic Rhinitis belongs to this category. Menopause or very irregular period having severe hormonal problem in some females can also cause Atrophic Rhinitis. Excessive crusting of the nose occurs resulting into nose blocking. Relief from blocking occurs only when crusting is removed. Removal of the crust may give rise to nose bleeding.

Excessive drying of mouth due to heat, less water intake, certain drugs like antihistamines which produce dryness of mouth can give rise to bad smell.

* Person gets various and changing types of smell but opposite person does not get that smell

Atrophic Rhinitis as mentioned above can cause degeneration of nerve of smell or alter the sense of smell. Ethmoid sinus infection (detail in chapter on ‘Sinus’) can also cause this type of symptom. Patient does not get smell of perfume, kerosene, fish, burning, etc. Such an individual is accident prone because he does not get smell of burning. As against this, person may get altered smell. Smell of perfume may smell like kerosene. Some cases of brain tumour produce this kind of altered smell.

INVESTIGATIONS :

 Blood routine

X-ray of Sinuses

X-ray Chest

Stool examination

Examination of nasal discharge

Check up by ENT specialist

Check up by Neurophysician in case of altered smell

Check up by Gynecologist if smell is after menopause or female having irregular periods

Biopsy of mouth ulcers, if any

Biopsy of nasal lining in suspected Syphilis, TB, Leprosy

TREATMENT :

Treat the anaemia or protein deficiency, Harmonal problem, sinus problem, lung condition, diarrhea, constipation, colitis, if any.

Atrophic Rhinits requires cleaning of nose with 1 tsf salt and 1 tsf soda-bi-carb(cooking soda) in lukewarm water. Water should be filled in an enema can and to be hanged at a higher level in bathroom. Enema can comes with long rubber tube and nozzle. Patient should sit on a stool, keep the nozzle in one nostril till half the can empties. Repeat the cleaning in other nostril for the remaining water.

* Dinoestrol or Evalon Cream used in dryness of vagina (Atrophic Vaginitis) is good even in all types of atrophic rhintis (Not necessarily in women)

* Injection Streptomycin 1 gm bulb powder dissolved in 5 cc distilled water to be used as NOSE DROPS 3 to 4 times a day.

*Kemecetine Antiozaena nose drops. 2 to 3 drops 3 times a day

* Injection of plcentral extract in the nose.

* Vit. A & E orally

SURGERY 

Atrophic Rhinitis requires closure of one side of nose from inside. One side of the nose is put to ‘Rest’ for the secretary glands and hair to regenerate. Surgery is carried out under local anaesthesia and requires appx. 6 hours of hospitalization. The closed nostril is opened after 6 months to one year and at that time another nostril is closed. Surgery is done from inside the nose. There is not cut or stitches outside. The shape of the nose does not get affected. Fear of the patient that he will not be able to breath is unfounded. One nostril is open and good enough for inhalation.

In another procedure, plastic or teflon implant is introduced in the floor of the nostril to reduce the nasal cavity. Both sides of nostrils can be operated at the same time. Implant remains permenant in the nose without any side reaction.

RESULT OF TREATMENT

Let me confess. Result of the medical treatment or surgery is FAIR and not excellent. Reversal of nasal condition is not achieved 100 %. But this kind of surgery is the only solution to get partial relief and to check the progress of the disease.

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LET’S SMILE

Lady went to a doctor, “ I fart every now and then.  Luckily neither I get smell nor I can hear that. I did that twice just now”.

Doctor scribbled something and gave it to her. She asked, “ What you have prescribed?”

I have written, “ First we will fix your nose and then ear”