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Has recurrent odour in nose by allergies. Takes nasonex and allegra. How to overcome this?

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My husband has recurrent odor in his nose precipitated by allergies, he is tired all of the time, and struggles to clear his passages. The smell is characteristic of a bacteria the name of which I once knew. ( pseudamonas?sp? rings a bell with me). He has been addressing it with nasal rinses. I am concerned because this has been going on for months.
He takes Nasonex and allegra. Honestly, I do not want him to kiss me the smell is so bad. Should we see a doctor? If so, what type of doctor
Posted Sat, 22 Jun 2013 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 40 minutes later

Thank you for your query.

1. The Pseudomonas may be a resistant strain. Get a bacterial/ fungal culture and antibiotic sensitivity done on nasal swabs taken during nasal endoscopy.

2. Stasis of nasal secretions leads to a build up of waste products of inflammation, infection, immune system by-products and gases like nitric oxide and ammonia.These toxins get absorbed easily into the blood as the sinuses have a large XXXXXXX surface area. This causes the tiredness, feverishness and fatigue.

3. In addition, due to their unique design, airflow through our sinuses and their ventilation occurs gently and passively during expiration.This causes the recurrent odor.

4. Another interesting concept is 'Biofilm' formation in his sinuses. There may be associated allergic, fungal and mucus related conditions. The simplest example of Biofilm is the sludge or slime seen in drainage pipes or the moss seen along water channels. The Biofilm represents colonies of different types of bacteria living together like a 'city' with different micro organisms taking up different tasks or 'profession's like we do in our communities. Some of them secrete a matrix that protects them all. Due to close proximity, these bacteria share genetic material and may be genetically distinct from those that are grown in lab cultures. Hence they do not respond to the same antibiotics that they show sensitivity to in lab studies. Bacteria like Pseudomonas are notorious for antibiotic resistance and can cause other species to become more resistant by exchange of genes and chemicals.

5. He should wash his sinuses with a solution of normal saline with a pinch of salt and baking soda added to it. This alkaline nasal douche will help break up the Biofilm and allow penetration by other antibiotics. Your doctor may add an antibiotic like tetracycline or chloramphenicol. However this should be done under medical supervision. Supportive treatment such as mucolytics, anti allergics, anti fungals, steam inhalation and dental hygiene should be taken.

6. Since the smell is apparent to you, it is unlikely to be an olfactory hallucination or damage to the (olfactory) smell area of the nose.

7. Conditions like atrophic rhinitis, post nasal drip and acid reflux may also co-exist. Get a detailed ENT evaluation done. You may share the results of any investigations, including a Sinus CT, for further treatment advice.

Hope I have answered your query. If you have any follow up queries I will be available to answer them.

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