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What causes constant aberrant smell in nose?

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Posted on Sat, 16 May 2015
Question: Hi. For about 6 months I've had a chlorine smell in my nose and wake up with a cough that usually lasts all morning. I've also noticed a sharp pain and numbness in my legs. I am overweight (6'5", 380 lbs.) And I have high cholesterol and high blood pressure that I take medication for.
doctor
Answered by Dr. Dariush Saghafi (2 hours later)
Brief Answer:
Aberrant smell needs to be worked up

Detailed Answer:
Good evening.

I am a neurologist from the XXXXXXX Ohio region of the world. The approach to any patient who complains of aberrant smells of any type should be thoroughly evaluated since the source of the problem could be in the nose, in the sinus passages, or in the brain.

Typically, the workup is best done by an ENT specialist since many cases end up with primary problems either in the nose or structures related to the nose which can be corrected rather easily. If, however, the ENT specialist does a thorough investigation and comes up with nothing obvious then, a neurologist may be asked to step in (such as myself).

Things such as infections high up in the nose itself can be the cause of odd smells that don't seem to abate if the infection is untreated and especially if it becomes granulated or abscessed. Also, infections of any of the sinuses will do the same thing. Usually, there will be a lot of very thick and nasty drainage that comes on throughout the day and especially upon awakening. You say that you cough a lot. Do you know if that's due to an increase in drainage that may be going down the throat? Or do you feel that it is an increased amount of sputum you're bringing up from the lung and the bronchi? Also, infections of the lungs could cause you to sense an odd or aversive smell. Therefore, Chest X-rays should be obtained looking for some type of abscess or infectious sources in the lungs.

I can't tell you the specifics of how an ENT person would go about looking at this problem but suffice it to say they have the equipment, tools, and tests that will be able to rule out a problem in that region of the body. When the case is passed on to me I can tell you that my first order of business is to verify and ascertain if a patient suffers from any alterations of smell by applying a SIT (Smell Identification Test). Once, we decide on how intact or not the smell sense is I would likely get an MRI of the brain with contrast medium since there are certain things that can cause alteration of smells from tumors to hemorrhages and strokes. You are certainly at risk for stroke with your condition of being overweight and having high cholesterol as well as blood pressure. There is also the possibility that an aneurysm that is compressing or irritating either a portion of the brain responsible for smell interpretation or compressing the olfactory bulbs themselves could be present and therefore I would probably get an MRA of the brain and see if something shows up there.

Seizures are also a possibility but the description of your problem doesn't give me the gestalt of an epileptic condition which usually has a totally different type of smell associated other than chlorine. And by the way, I don't know what the significance of chlorine is in your case because I'm not aware of that particular smell being indicative any particular pathology as other smells can be.

As far as the pains in your legs and numbness I believe that is likely a completely separate problem and would need its own workup to rule out some type of compression of the nerve roots in the back which are likely being compressed due to the issue of weight. Obviously, a weight loss or exercise program would be in your best interest and would expected to have a better than average chance of helping your pain symptoms if you could start a program to get closer in to your ideal body weight.

If this answer satisfactorily addresses your question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback.

Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived for further reference by colleagues as necessary.

Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

All the best.

The query has required a total of 32 minutes of physician specific time to read, research, and compile a return envoy to the patient.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dariush Saghafi (2 days later)
I definitely have drainage that is making me cough, but I would say that most of my coughing is due in large part from chest congestion. When I breathe deeply I wheeze and always cough. Sometimes I cough up phlegm, sometimes it is nothing but the chest congestion and wheezing usually keeps up for at least half of the day. In the afternoon it tends to subside more.

In terms of the chlorine smell, it is what just came to mind. It is more of a chemical smell than anything and I most closely relate it to Chlorine.

I was reading of my symptoms online and read that kidney disease and/or failure could also be causing these symptoms. Could that also be the case or am I being too paranoid?

What type of doctor would you suggest that I see?
doctor
Answered by Dr. Dariush Saghafi (22 hours later)
Brief Answer:
Treat drainage with drying agent

Detailed Answer:
Good morning. Thank you for the updates on your question and here are some return responses to that information.

If you are having definite sinus drainage or bronchial phlegm that is causing you to cough then, that needs to be addressed. Wheezing is always a sign of bronchial constriction and often is due to reactive airway issues, asthma, COPD, or aspiration. You may also have sleep apnea which is a sleep disturbance coupled to respiratory alteration which can affect cardiac function. If heart congestion develops secondarily to this problem then, wheezing can occur due to backup of fluids in the lungs.

The bottom line is your doctors need to look for and address the cause of your wheezing and give appropriate medications or interventions (nebulizations, medications, breathing machines, weight loss plans, etc).

As far as kidney disease causing the smell...again, I've detailed how I would recommend working up your symptom of odd smells (be they chlorine or anything else)...first things to do would be to rule out an actual process WITHIN the nasal passages, airway, and then, looking at the central nervous system in terms of the brain where it is not uncommon to find small tumors or other mass lesions pressing or compressing structures such as the olfactory bulbs, taking up space in the olfactory grooves, or within the uncinate gyrus where smells are captured, transmitted, and processed. Once those 2 systems have been cleared then, I would move off to other body systems that could be related. If you've had any lab work done in the past couple of years I'm sure your doctors would've told you whether or not you were suffering from kidney disease....that's pretty easy to detect. Personally, it wouldn't be a concern of mine if I knew my kidneys were good to begin with....but again, checking with your doctor on their status is as easy as asking the question for previous labs or getting a little blood drawn.

My suggestion is you consult ENT first to look at the respiratory areas for the chlorine smell. Depending on what they find the wheezing may or may not need to be further addressed by either an allergist, pulmonologist, or good internist.

If you smoke cigarettes or live in an environment where there is second hand smoke...STOP THAT ACTIVITY. Get checked for sleep apnea which I think you should do anyway just based on the symptoms you're having and your overweight condition because I think there's at least a 50/50 chance you have that problem as well and may not even be aware of it until it really starts catching up with you in the form of cardiac distress.

If this answer satisfactorily addresses your question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback.

Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived for further reference by colleagues as necessary.

Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

All the best.

The query has required a total of 47 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Dariush Saghafi

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Practicing since :1988

Answered : 2474 Questions

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What causes constant aberrant smell in nose?

Brief Answer: Aberrant smell needs to be worked up Detailed Answer: Good evening. I am a neurologist from the XXXXXXX Ohio region of the world. The approach to any patient who complains of aberrant smells of any type should be thoroughly evaluated since the source of the problem could be in the nose, in the sinus passages, or in the brain. Typically, the workup is best done by an ENT specialist since many cases end up with primary problems either in the nose or structures related to the nose which can be corrected rather easily. If, however, the ENT specialist does a thorough investigation and comes up with nothing obvious then, a neurologist may be asked to step in (such as myself). Things such as infections high up in the nose itself can be the cause of odd smells that don't seem to abate if the infection is untreated and especially if it becomes granulated or abscessed. Also, infections of any of the sinuses will do the same thing. Usually, there will be a lot of very thick and nasty drainage that comes on throughout the day and especially upon awakening. You say that you cough a lot. Do you know if that's due to an increase in drainage that may be going down the throat? Or do you feel that it is an increased amount of sputum you're bringing up from the lung and the bronchi? Also, infections of the lungs could cause you to sense an odd or aversive smell. Therefore, Chest X-rays should be obtained looking for some type of abscess or infectious sources in the lungs. I can't tell you the specifics of how an ENT person would go about looking at this problem but suffice it to say they have the equipment, tools, and tests that will be able to rule out a problem in that region of the body. When the case is passed on to me I can tell you that my first order of business is to verify and ascertain if a patient suffers from any alterations of smell by applying a SIT (Smell Identification Test). Once, we decide on how intact or not the smell sense is I would likely get an MRI of the brain with contrast medium since there are certain things that can cause alteration of smells from tumors to hemorrhages and strokes. You are certainly at risk for stroke with your condition of being overweight and having high cholesterol as well as blood pressure. There is also the possibility that an aneurysm that is compressing or irritating either a portion of the brain responsible for smell interpretation or compressing the olfactory bulbs themselves could be present and therefore I would probably get an MRA of the brain and see if something shows up there. Seizures are also a possibility but the description of your problem doesn't give me the gestalt of an epileptic condition which usually has a totally different type of smell associated other than chlorine. And by the way, I don't know what the significance of chlorine is in your case because I'm not aware of that particular smell being indicative any particular pathology as other smells can be. As far as the pains in your legs and numbness I believe that is likely a completely separate problem and would need its own workup to rule out some type of compression of the nerve roots in the back which are likely being compressed due to the issue of weight. Obviously, a weight loss or exercise program would be in your best interest and would expected to have a better than average chance of helping your pain symptoms if you could start a program to get closer in to your ideal body weight. If this answer satisfactorily addresses your question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback. Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived for further reference by colleagues as necessary. Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi All the best. The query has required a total of 32 minutes of physician specific time to read, research, and compile a return envoy to the patient.