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Experiencing a strange smell with thick yellow mucus. How to get relief?

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ENT Specialist
Practicing since : 1991
Answered : 2543 Questions
I am an allergy sufferer who after years of being able to control symptoms with benadryl or claritin ( and even flonase) recently began sounding more nasal and experiencing a strange smell without any other symptoms. This started over a month ago. I tried flushing with saline solution for a few days but after using the saline solution I came down with a head cold. The cold lasted a few days and everything seemed fine. But then the congestion returned about five days ago with a clear post nasal drip whenever I bend my head over. Now this morning I noticed the strange smell again along with thick yellow mucus. The smell only seems noticeable when i bend over. I do want to point out that before this started I was swimming in the beach (caribbean) two months ago on vacation. The saltwater seemed to clear my nasal passages tremendously at that time; but I do not know if it is connected to the triggering of this whole process.
Posted Tue, 23 Oct 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 21 minutes later

Thank you for your query.

1. Parosmia / Cacosmia or an altered strange smell may be experienced due to an number of reasons such as:
a. Nasal infections and chronic sinusitis, in your case a specific nasal sinus.
b. Damage to the olfactory system due to any severe infection, head injury, exposure to solvents and volatile chemicals. What is your occupation?
c. Metabolic diseases such as hypothyroidism, liver dysfunction. Do you smoke or have alcohol? Have you undergone blood tests?
d. Rarely, degenerative brain disorders such as Parkinson's and Alzheimer's. Have you ever suffered from Epilepsy?
e. CT / MRI of the Brain and Para Nasal Sinuses may be required.

2. The strange smell that you get through your nose is most likely due to a mild sinus infection or stagnant mucus including drying up of normal nasal secretions. Have you had a recent cough or fever in addition to your cold? The inflammation may be fungal. This would explain the thick mucus. Yellow color is more in favor of a mixed allergic or bacterial infection. Foreign bodies are rare in adults but must be ruled out if it is one sided. A rotten smell usually means a sulphur or a methane containing compound usually produced by a bacterial infection. You may discuss the possibility of Biofilm formation in your sinuses with your physicians. Sometimes there are fungal infections and build up of waste products of inflammation, infection, immune system by-products and gases like nitric oxide and ammonia. This would explain the strange smell which you experience. Due to their unique design, airflow through our sinuses and their ventilation occurs gently and passively during expiration. This may explain why you get the smell at different times.

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

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

5. Get a general check-up done as many diseases such as diabetes, liver diseases, nasal polyps, tumors and so on should be ruled out.

6. The sinuses may harbor silent infection. Fungal infections may exist only within the sinuses (as against invasive fungal infections) and yet cause allergic reactions. This constitutes Allergic Fungal Rhino Sinusitis (AFRS). Such fungal infections may be missed out on CT Scans and requires MRI Scans to detect. 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.

7. 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? Conditions like atrophic rhinitis, post nasal drip and acid reflux may also co-exist.

8. You should get the post nasal fluid collected in a sterile container and get it tested to rule out a CSF (Cerebro Spinal Fluid) leak. Get a Beta-2 Transferrin test on the fluid, if available.

9. A simple test is the 'Handerchief Test': Normal nasal secretions contain mucus which will stain and stiffen a soft handkerchief on drying, but CSF will not.

10. Get a CT PNS (Para Nasal Sinuses). done. If a CSF leak is suspected, a CT cisternography and MRI with contrast should be done. Spontaneous leaks may be multiple. Rarely, a low pressure CSF leak is linked with neuronal migration disorders.

11. Sea water salinity is very strong compared to the normal saline washes which are recommended for nasal and sinus washes. This high salinity has a high osmolarity and damages the delicate nasal and sinus mucosa, and may allow fungi to take root. This may be the connection to the whole process.

12. 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.

Above answer was peer-reviewed by
Follow-up: Experiencing a strange smell with thick yellow mucus. How to get relief? 2 days later
I took your advice and visited an ENT. They performed an examination including ear, throat and the insertion of a camera into the nasal passages. They confirmed that there was some inflammation but did not see anything that would be considered major (no polyps, nothing that would indicate fungal infection etc.). However, because there is obviously some type of infection which has been occuring, they prescribed sulfamethoxazole-tmp DS for 2 weeks along with prednisone 10mg (to reduce inflammation??). I am supposed to do a follow up visit in two weeks at which time they will do a CT scan to confirm that everything has cleared up. Any thoughts?
Answered by Dr. Sumit Bhatti 3 hours later

Thank you for writing back.

1. As mentioned above, this is most likely due to a mild sinus infection or stagnant mucus including drying up of normal nasal secretions.

2. it is good to hear that your ENT examination is normal except for mild infection. You will know sooner if the medication is working if the strange smell reduces or disappears.

3. If it does not, it may be fungal or a mixed allergic / bacterial infection.

4. Get the CT PNS (Para Nasal Sinuses) done, if necessary.

5. You may follow up with the results of the above 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.

Above answer was peer-reviewed by
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