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Have coated tongue, mucous in throat, Getting bad taste and breath. Should I continue GERD medicine?

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ENT Specialist
Practicing since : 1991
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For years i suffered with mucous in the back of my throat this was finally eased after 6months of nasal spray and sinus rinsing however i have been left with horrendous death smelling breath and a rotten taste at the back of my throat, i started to notice bad breath when i was roughly 14 however this has got alot worse since the mucous has cleared up. It almost feels that clearing the mucous has exposed the problem which has been there for years. I also have a dry throat, and a sensation of something stuck particularly the right side. Sometimes when i eat of cough the smell/taste gets worse, it is also at the roof of my mouth right at the back where it appears to go up towards my sinus area. Alcohol also seems to make it significantly worse and my throat is extremely dry when dehydrated following day.
Since the mucous has cleared up the breath and taste has got alot worse and affects me every day, ruining my confidence I am constantly sucking on sweets in a bid to keep my mouth moist and in an attempt to hide my bad breath. Over the last two years i have been prescribed, anti-biotics (although blood tests showed no infections) as well as two different tablets for treatment of GERD and also a 1month course of meds they give to children with asthma, but nothing seems to be improving the bad breath or sensation in my throat. 3 months ago i was referred to ENT a camera down my throat which revealed a enlarged tonsil but said everything else looks normal. When i said since the mucous had cleared i have been struggling to breathe through my right nostril (same side as enlarged tonsil) she said a small operation may correct this and referred me for a CT scan of sinus'. The ENT thought the bad smell and taste is due to GERD and prescribed 1 x 30mg twice daily for six weeks, i have been advised to now lower the dose to 1 x 30mg daily however there is no improvement. I think the tonsil is enlarged all of the time and i feel it more when i get a dry throat. The ENT mentioned food may be getting trapped in the tonsil and decaying and that i may 'get used to it and have to learn to live with it' by gargling. I cannot see any tonsil stones but if i put pressure on the tonsil it sometimes releases a foul taste/liquid (once a month or so). My breath is always worse in the morning and i am aware of the death taste coming from right side back of throat. Bloodtests however have not shown infection and i do not often get sore throats. Gargling with salt water/mouth wash has not improved this. I also constantly have a coated tongue and bumps on the back of my tounge, I scrape it 3 times a day but still have the rotten taste coming from throat. I have good oral hygiene and have been to two dentists who say my teeth and gums are in good health so this is not dental. I am pretty sure this is not coming from my stomach as when i burp it is not the same smell as the bad breath. Can you shed any light on this? Do you think there is a connection with not being able to breathe through right nostril and only the right tonsil constantly enlarged? Why do i constantly have a coated tongue? I am at whits end this rules my life and has also ruined my confidence. I have an appointment with ENT in 2 weeks time to discuss a sinus CT scan will be devastated if she just tells me to continue on GERD meds and 'learn to live with it'. .
Posted Fri, 26 Apr 2013 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 1 hour later

Thank you for your query.

1. First get that a plain CT PNS (Para Nasal Sinuses) with 1 mm coronal , axial and sagittal views done. This is the gold standard investigation to check for any sinusitis or nasal obstruction.

2. I would recommend a slight modification of the Scan protocol. Ask for a pre and post decongestion CT PNS Scan. After the first Scan get a liberal amount of Otrivin (0.1% Xylometazoline) Nasal drops should be instilled in the nose and the CT PNS repeated.

3. The images can then be compared to check for the exact site of the nasal obstruction. Any improvement in the symptoms or reduction in the smell should be noted.

4. Stagnation and thickening of nasal secretions or an excess production due to some chronic irritation or inflammatory process, is usually due to a deviated nasal septum, hypertrophied turbinates and also some problem in the sinuses. The source of the mucus is the nasal cavity and sinuses, which have a large XXXXXXX surface area and can produce a large amount of mucus. This post nasal drip irritates and infects the throat. Here gargling does not help.

4. There are some possibilities that you must discuss with your ENT Specialist:
a. More than one source. Sinusitis, nasal obstruction, post nasal drip, a coated tongue, chronic tonsillitis may co-exist.
b. Dehydration is a common cause for a coated tongue.
c. Decreased Salivation.
d. Fungal infections and 'biofilm' formation.
e. Parosmia or Olfactory problems.

5. You may share any investigations, such as clinical and operative notes, Sinus CT scan images for further treatment options.

I must emphasize that this is a common treatable problem and not a cause for worry.

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

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