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What causes foul smell in the nose post sinus surgery ?

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I smell a stink in my nose after sinus surgery. It started 3 weeks after surgery, it has now been almost 4 weeks. What is this and when will it improve. I have been using saline spray and neti pot.
Posted Sun, 22 Apr 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 8 hours later

Thank you for your query.

1. These problems usually persist for up to four to six weeks post-op. Total healing of the XXXXXXX surgical wounds can take up to six months depending upon the extent of surgery.

2. Mucociliary function can take up to twelve weeks to return to normal after sinus surgery. This causes stagnation of normal sinus secretions, leading to repeated infections.

3. As long as you do not have fever, there is no cause to worry. However your nose and sinuses require routine endoscopic inspection and cleaning.

4. Usually the crusts formed in the nose after surgery are extensive and have to be removed by the surgeon as they may not be expelled by saline nasal sprays and nasal irrigation.

5. What do you use for the neti pot? Do not use tap water with table salt. Common household salt contains iodine and anti-caking agents which irritate the post-operative mucosa. Use Normal Saline solution.

6. If this problem persists, have a nasal endoscopic check done for recurrent sinus blockage. Insist on a sinus swab for culture and sensitivity. Biofilm formation in the sinuses is another cause for resistant infection, not responding to medication.

7. Is it possible to compare your pre-operative scan images with your operative notes? Was radio-frequency ablation used for reducing the turbinates? Is there any septal swelling? Is there any post nasal drip?

Anticipating your response.
Above answer was peer-reviewed by
Follow-up: What causes foul smell in the nose post sinus surgery ? 2 hours later
So, do you think the bad smell is due to the scabs? The doctor saw no sign of infection last Thursday, but I continued the antibiotic since I smell a horrible smell when I breathe in. No one else smells it, just me. It seems to be mainly or entirely from the right nostril which wasn't cleaned out. Doctor said the right looked good except for some swelling. The left was most blocked at that time with lots of uncomfortable post nasal drip and swelling. Still have post nasal drip on both sides. I think the swelling is less due to the steroid spray and cortisone shot.
I don't know if I had radiation, I doubt it, it wasn't mentioned anyway. I think just cutting. Would biofilm formation cause the bad smell and post nasal drip?
Funny, I am a hypnotherapist so made myself small and looked around in my sinuses. What I saw (before talking to you) was a yucky film on the inside walls of my sinus cavity and some swelling around the openings. How large are the openings anyway? I believe they may have been enlarged. I certainly breathe more freely now! And what causes the headaches? My doctor said I may have bone pain but what causes that? The headaches just appear any time of day, but usually in the evening. My last really severe one was Friday.
Answered by Dr. Sumit Bhatti 2 hours later

Thank you for writing back.

1. All this means that the sinuses are still healing and you will have to wait for a few weeks.

2. Assuming that you have had an endoscopic examination, only some swelling may be present which should settle down. Continue with the steroid spray as long as there is no acute infection or fever.

3. The smell will be related to the infection that has not yet been fully cleared. The post nasal drip is associated with longer healing time. Biofilm is a topic which must be discussed with your physician if this foul smell does not subside.

4. You seem to have a special ability to look within yourself. Sinus ostia (openings) are usually small and hidden from view, so enlarged openings should promote ventilation, drainage and therefore, healing. Normal sinuses will have healthy mucosa (lining) inside and no coating/ discharge.

5. Many patients experience nonspecific mid-facial pain after sinus surgery. This is because of many small unnamed nerves which are damaged during sinus surgery. However, true headaches signify that either the sinus inflammation / infection still persists or that there was also another cause besides sinus pathology. Since you have a decrease in the frequency of your headaches, you should wait. You may request your physician for medication to control the headaches till they subside or to re-evaluate if they still occur.

6. Radio Frequency is not radiation, but a low temperature cautery. It causes tremendous tissue response for a few weeks post op, so much that sometimes it appears that there has been a worsening of symptoms in the initial weeks after surgery. It requires many weeks to settle down.

Hope I have answered your query. If you have any follow up queries I will be available to answer them.

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