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Have chronic bad breath and body odour. Throat swab test done. How long will it take to get cured?

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I have chronic severe bad breath and body odor.

Following are the findings of CT-PNS:
Deviation of the nasal septum towards the right side with bony angular spur.
Hypoplastic bilateral frontal sinuses noted.
Paradoxical bilateral middle turbinate in middle noted with neumatisation of the vertical lamella.

Following are the findings of SURVEILLANCE CULTURE AND SENSITIVITY for Throat Swab test:
Gram Stain      : Gram positive cocci in single pair seen
Organisms Grown: Viridans Streptococci

My all blood tests are normal, Gastro-Duodenoscopy is normal, chest PA View is normal according to the Pulmonologist, no oral problem as per Periodontists, no diabetes and no other problem/discomfort.

I also had tonsillectomy as suggested by ENT doctor a year ago.
The removed tonsils had severe bad odor, but the problem didn't disappear.
So, what do you think is the cause of the severe bad breath and body odor problem based on above test results?
Do you recommend any further tests to come at a conclusion?
How much time will it take to cure completely?
Posted Tue, 14 Aug 2012 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Naveen Kumar 2 hours later
Hi XXXXXX

Thanks for the query

Bad breath also known as halitosis is caused due to various causes, such as sinusitis, mouth breathing, acid reflux disease, laryngo-pharyngeal reflux, poor oral hygiene, coating over the tongue, dehydration, etc.

As most of the causes has already been ruled out, finally we are left with sinusitis, laryngo-pharyngeal reflux and coating over the tongue.

Paradoxical middle turbinates and the deviated nasal septum could cause nasal block and hence mouth breathing. In the presence of mouth breathing, there will dryness of the salivary secretions and the mucosa of the oral cavity giving rise to halitosis. The mouth breathing can be reduced by using saline/steroid nasal spray, followed by steam inhalation for few days and drinking plenty of warm water.

Secondly, laryngo-pharyngeal reflux can bring out the bad odor from the stomach into the throat, hence giving rise to halitosis. Even though the OGD scopy is normal, there can still be a micro reflux which could be causing this problem. This can be corrected by using a proton pump inhibitor (such as Esomeprazole, Pantoperazole) and a prokinetic (such as domperidone).

Finally, do the tongue cleaning at least twice a day to remove the coating over the tongue. Drink plenty of warm water, gargle the mouth every time after having food, this reduces the stagnation of the food particles over the tongue and between the teeth.

Also, avoid food items containing excessive garlic and onion, dairy products and coffee.

Hope this answers your query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: Have chronic bad breath and body odour. Throat swab test done. How long will it take to get cured? 2 days later
The severity of my bad breath and bad body odor is too severe.
My bad breath can be felt till 10-15 feet and body odor till 5-6 feet and both are severe.
The problem is that I don’t feel it at all and also can't mask it as it is very severe.
It has ruined my career and social life.

It all started in year 2000 because of a tooth cavity in a molar which was caused by the wisdom tooth protruding at 45 degree angle.
After 4 years in 2004 I got that wisdom tooth extracted and RCT done on the damaged tooth.
Two years later, in 2006, there was food lodging in the RCT cap also and that tooth was also extracted.

What can be the possible causes of such severe bad breath and body odor?

In response to the possibilities mentioned by you:
1.     I have no mouth breathing, even while sleeping, and hence no dryness of the salivary secretions.
2.     Can laryngo-pharyngeal reflux produce so severe bad breath? Or what else may be the possibility for such severe bad breath?
I’m attaching the Laryngoscopy report and Video Laryngoscopy report performed at two different hospitals. In one report, the finding is written as laryngo-pharyngeal reflux with question marks meaning not sure, just a possibility. Please provide your opinion based on findings in these reports. What is the test to make sure if it’s laryngo-pharyngeal reflux or not?
3.     I brush after waking up in the morning and before going to bed also; clean tongue thoroughly using tongue-cleaner after brushing both the times and also use mouth wash. I MAINTAIN PROPER ORAL HYGIENE, BUT THE BB AND BO ARE BECAUSE OF SOME MEDICAL PROBLEM (MAY BE SOME KIND OF INFECTION). You may advice better.
4.     I don’t consume garlic at all and also don’t take raw onion. In dairy products, I take milk on daily basis and don’t take coffee at all.

Please don’t take my problem lightly. It can’t be cured with any home remedy or with some precautions. Please tell me what can be the possible reasons of such severe bad breath. It started with the dental problem only and now it’s become so severe after being there for many years.

I’m repeating below some findings (which I mentioned in my original mail) which I think you should pay more attention on and tell me the cause for the same:
•     I also had tonsillectomy as suggested by ENT doctor a year ago.
The doctor handed over me THE REMOVED TONSILS WHICH HAD VERY SEVERE BAD ODOR. THAT SEVERE BAD ODOR STILL CONTINUES.

Please tell what I should do next to conclude the problem and start treatment for the same.
 
 
Answered by Dr. Naveen Kumar 23 hours later
Hi

Thanks for writing back

I do understand your concern behind this problem. I will try my best to help you out to identify the root cause of this problem and overcome the same.

I do have gone through the reports attached and it is almost normal.

To answer you in detail:
1.     Can laryngo-pharyngeal reflux produce so severe bad breath? Or what else may be the possibility for such severe bad breath?
A:     Yes, laryngo-pharyngeal reflux (LPR) can cause halitosis, but it might not be as severe as you are describing. Moreover, LPR does not cause any body odor. Other causes of bad breath and the body odor have to be investigated.

2.     What is the test to make sure if it’s laryngo-pharyngeal reflux or not?
A:     24 hour acid PH monitoring in a specialized centre can help in identifying the LPR.

3.     It started with the dental problem only and now it’s become so severe after being there for many years.
A:     Even though your problem has started since the day you were diagnosed to be having dental problem, I doubt the possibility of the fetor to remain for so long, post dental extraction and more so after tonsillectomy. Another strong concern of mine is the possibility of sinusitis or atrophic rhinitis which has to be confirmed with a CT scan of the paranasal sinuses.
If the above scan proves to be normal, then the other set of investigations to be performed are the thyroid function test (thyroid disease), blood sugar levels (diabetic status) and urine test (the ratio of trimethylamine to trimethylamine oxide) to rule out Trimethylaminuria.
There's certainly no direct relation between these two problems. Few studies claim the body odor and chronic halitosis could be signs of presence or production of various toxins in the gastrointestinal tract. These toxins are later absorbed into the bloodstream which can cause body odor, halitosis, flatulence, bloating, etc.

Other metabolic problems such as hyperthyroidism, diabetes and trimethylaminuria have to be ruled out. Hence a thorough evaluation and appropriate management should be aimed at relieving the symptoms.

Trimethylaminuria is a rare metabolic disorder that impairs the ability of an enzyme to metabolize or transform the compound Trimethylamine (TMA). Unoxidized Trimethylamine, is excreted in the perspiration, breath, saliva, and urine, resulting in extremely bad breath and body odor. Hence I would also suggest you to consult a good endocrinologist for a complete evaluation.

Avoid foods such as egg yolks, legumes, red meats, fish and beans.

You can also try the following:
1.     Tablet Chlorozyme Fresh - an herbal mixture containing chlorophyll (deodorizer) and various other vitamins which can reduce both the bad breath and the body odor to a certain extent.
2.     Drinking plenty of warm water.
3.     Eating fresh fruits and vegetables.
4.     Saline nasal spray 3-4 times a day.
5.     Deodorant or an antiperspirant - deodorants make the skin more acidic, and prevent growth of bacteria. An antiperspirant blocks the sweating action of the glands, resulting in less sweating.
6.     Taking bath 2 times a day with warm water.
7.     Alum to be mixed in the water used for bathing – it reduces body odor.

Hope you are convinced with this response; if you are having any further queries you are welcome.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
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