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On lisinopril for hypertension and bupropion for depression. Why am I getting acidic smell in nose?

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ENT Specialist
Practicing since : 1991
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Hi. I'm a 51 year-old male. For several months I have noticed a smell in my nose. It's an acrid/ almost car exhaust kind of smell. Sometimes it's so strong it almost burns. It's driving me crazy. I thought it was a smell associated with my house's HVAC, but I smell it at work (school) and in my car, and even outside in the fresh air. I'm currently taking lisinopril for hypertension, bupropion for depression, an LD aspirin, zyrtec for allergies and pravastatin for cholesterol.
Any ideas? I haven't yet spoken with my health care provider.
Posted Thu, 3 Jan 2013 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 4 hours later

Thank you for your query.

1. The acid, car exhaust like smell that you get through your nose when you inhale is most likely due to a mild sinus infection or stagnant mucus including drying up of normal nasal secretions. Have you had a recent cold, cough or fever? The inflammation may be fungal. Foreign bodies are rare in adults but must be ruled out if it is one sided. A rotten smell usually means a sulphur containing compound usually produced by a bacterial infection.

2. Hence the first step will be to rule out the above by a visit to an ENT Specialist.

3. Oral infections, inflammation including gum and dental (any recent root canal or dental extraction?), acid reflux and Tonsilloliths are leading causes for a foul smell in the nose.

4. Get a general check-up done as many diseases such as diabetes, liver diseases, nasal polyps, tumors and so on should be ruled out. It may be drug induced as you are on multiple medications. For example both Lisionpril and Bupropion cause liver toxicity.

5. If there is nasal and sinus inflammation you may take a trial of treatment including antibiotics, anti-allergic decongestants, saline nasal washes, mouthwashes, tongue cleaning, anti-reflux medication and probiotics. Smoking should be avoided. Otherwise you may proceed through 3 & 4.

6. If no cause is found, it may be a an olfactory hallucination. This a commonly seen with damage to the olfactory mucosa or olfactory bulb and tract, esp. some years after a head injury. This will show up on imaging such as CT/MRI. Do you have any occupational exposure to extreme cold, constant air conditioning or chemicals such as a chemistry lab?

7. You may follow up with the answers to the above questions, results of the above investigations and treatment for further recommendations.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

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