Hi,

Thank you for your query.

1. If olfactory problems such as tumors and atrophy, and age related issues have been ruled out, then the smell of exhaust fumes may be cacosmia (altered smell) or from the Nitric Oxide (NO) produced in the sinuses and nasal cavity.

2. Exhaust fumes contain nitrogen traces of nitric oxide, besides carbon dioxide, carbon monoxide, ozone, un-burnt hydrocarbons, water vapor and soot.

3. I would like to see images (not the reports) of your previous CT/MRI scans. Get a plain CT PNS (Para nasal Sinuses) on a multi-slice CT Scan machine with 1 mm coronal, axial and sagittal cuts done.

4. The extent of previous sinus surgery may explain what is happening in your nose.
Recurrent sinus blockage may increase levels of NO, excessive surgery with persisting inflammation will cause a constant release of NO. NO levels can be measured. Poor ventilation and drainage of your sinuses is the most important cause of Biofilm formation.

5. You may discuss the possibility of Biofilm formation in your sinuses with your physicians. 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 E coli are notorious for antibiotic resistance and can cause other species like staph to become more resistant by exchange of genes and chemicals. (This may explain the type of bug that you are referring to).

6. You should wash your 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. You may add an antibiotic like tetracycline or chloramphenicol. However this should be done under medical supervision.
If you are preparing the saline solution at home,
(i) I will recommend that you use Normal Saline 0.9% which is used for IV infusions.
(ii) Household salt may contain anti-caking agents and too strong or too weak a solution will damage your delicate nasal mucosa.
(iii) If you still want to prepare the solution at home prepare a mixture of Sodium bicarbonate (loosens crusts) 50 gm, Sodium biborate (antiseptic) 50 gm, Sodium Chloride (for isotonicity) 100 gm and then add 1 teaspoon to 300 ml XXXXXXX warm water.
(iv) Another option is to add a pinch of baking soda to a pinch of common salt, + XXXXXXX warm water,
(v) Attach a piece of rubber catheter to a 20 cc disposable syringe. Keep your head bent forwards and downwards, mouth kept open while performing this alkaline nasal douche.

7. You may try higher generation antibiotics such as cefprozil or ceftriaxone, again to be administered only by your local doctors. You should draw their attention to Biofilm formation and NO which is a relatively new concept.

8. Supportive treatment such as mucolytics, anti allergics, anti leukotrienes, nasal steroid sprays, anti fungals, steam inhalation and dental hygiene should be taken. Surgical debridement, removal and disruption of the Biofulm requires repeat or revision surgery.

I hope that you do not have any other immune suppressive disorder such as diabetes. In such cases oral steroids are contra-indicated. Do you have any details of your dermoid tumor surgery?

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

Regards.

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