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Ask Dr Uzair Your Own Question
Dr Uzair
Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 7939
Experience:  MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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I had a foul smell in my nose last 8 months and the

Resolved Question:

I had a foul smell in my nose for the last 8 months and the ENT has tried several antibiotics and creams. I also use nasal wash with salt and bicarbonate of soda. The smell is there with a nasal discharge some of the time. Can you help please
Submitted: 2 years ago.
Category: Medical
Expert:  Dr Uzair replied 2 years ago.
Dr Uzair :

Hi. Welcome to JustAnswer. I shall try my best to assist you while you are corresponding with me.

Dr Uzair :

Can anyone else smell this odor as well?

Customer: No they can't
Dr Uzair :

Alright, any alteration in the taste?

Customer: No alteration to taste
Dr Uzair :

Alright, do these smells turn on and off during the day or do they remain fairly constant throughout the day?

Customer: They turn on and off
Dr Uzair :

Okay, do they aggravate when you are emotional, sneeze or sniff in forcefully?

Customer: No
Dr Uzair :

Have you had a CT scan of the nasal sinuses and the brain?

Customer: Yes I had a CT scan and everything was normal
Dr Uzair :

Okay, post nasal drip?

Customer: Yes
Dr Uzair :

Heart burn?

Customer: No
Dr Uzair :

Okay, any previously diagnosed medical conditions?

Customer: Not related to this I have metatastatic tonsil cancer
Dr Uzair :

Okay. Medication?

Customer: I have a very long list of medication and not enough time this morning
Dr Uzair :

Sure. Have the antibiotics been able to take the symptoms down while you've been on the,?

Dr Uzair :

them*

Customer: Some of them have in the first five days but after a month of taking them the smell has returned
Dr Uzair :

Okay, thank you for being very patient during the q and a.

Customer: No problem
Dr Uzair :

There are a few things that come to mind, the first thing that I would like you to get done is a nasal swab and have it sent for fungal cultures since it is obvious that this is not bacterial and more likely to be fungal in origin, because it is recurrent, you've had multiple course of antibiotic therapy and you are on chemotherapy due to the metastatic tonsillar ca.

Customer: Yes I can ask for that
Dr Uzair :

The chemotherapeutic drugs, multiple courses of antibiotics render the organisms resistant and in the back drop of resistant recurrent bacterial infections, fungal infections can take charge. And these are a notable cause of bad odor with nasal discharge.

Customer: Ok
Dr Uzair :

You can be started on empirical antifungal nasal creams as well as oral anti fungal agents while you wait for the culture results to come by, once they are back and a fungal infection has been identified, these anti fungals can be changed to the ones that the fungus is sensitive to.

Dr Uzair :

Sometimes, due to colonization, it is best to have a bilateral antral washout done, in which the ENT washes the sinuses and the nose and naso pharynx with antifungals, antibiotic and irrigation solution.

Dr Uzair :

Along with some endoscopic debridement of identifiable colonies of the fungus.

Dr Uzair :

This reduces the fungal load and the anti fungals work better.

Dr Uzair :

This combination therapy has shown the best results with fungal colonization with minimum recurrence.

Dr Uzair :

Once, the symptoms subside and the infection is under control, you will need to remain on anti fungals prophylactically for 6 to 8 months.

Customer: Thank you very much
Dr Uzair :

To avoid any recurrence.

Dr Uzair :

And another thing, please do get a CT scan with contrast done of the brain, if you have not had that done.

Dr Uzair :

Do you have any more queries, related to this?

Customer: Great I will be asking for these asap
Dr Uzair :

Thanks a lot. And please do take care.

Customer: thanks I'll be asking for these ASAP. All the best , Loni
Dr Uzair :

Please do leave a positive rating for the service.

Dr Uzair :

Thank you, Loni.

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