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What causes persistent bad smell in nose while treating sinus?

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Posted on Mon, 25 Jul 2016
Question: So I have been having a funny odor in my nose for three months. THought there was some improvement after antibiotics, cleaning out of sinuses and stents(with steroids put in) and nasal sinus rinses twice a day. Odor seems to be mostly back. Plus, my sense of smell is limited as it has been for past 3 years(had surgery 2 years ago...did not help sense of smell). At the time, had polyp biopsied and all was fine . So I decided to go to a "specialist" who is affiliated with a smell and test disorder clinic here in XXXXXXX VA. He was concerned about the location of the polyp (below my olfactory nerve) and wants to biopsy it(of course this made me nervous) , and he wants to inject steriods into the polyp, so a whole other surgical procedure. I contacted my regular ENT and reminded me of the biopsy previously done. I know it's a different polyp, but what is the change of it being cancerous with the history of sinusiitis, allergic rhinitis and polyps that I have. My regular ENT said to leave it up to me as to whether or not to proceed. He also said not to do the injection since I just had the stents put in (with steroids in them). So I am a loss. I am scheduled to see my regular ENT this week and will discuss further. I have another medicall issue going on, and I really don't want another worry(biopsy), Also, my ent has been concerned about removing that polyp which is near my olfactory nerve because of the fear of scarring and then losing all sense of smell. Is there anyone that can do that procedure ? I just feel that that polyp is causing all my problems right now. THanks.
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Answered by Dr. Sumit Bhatti (2 hours later)
Brief Answer:
Try hypertonic saline nasal washes with added steroid.

Detailed Answer:
Hi,

Thank you for your query.

1. If you can upload a few CT Scan and Endoscopic images, it will help me to understand the location extent and the size of this nasal polyp.

2. The smell in the nose can be attributed to local inflammation and round the polyp, fungal or bacterial infection, obstruct of airflow to the olfactory mucosa and previous surgery.

3. Hypertonic saline nasal washes should help. You can add half the contents of a a budesonide respule in the nasal wash.

4. An endoscopic biopsy or polyp excision with a debrieder (if medical treatment does not work) should be a simple procedure. An inverted papilloma should be ruled out.

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

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sumit Bhatti (16 minutes later)
Thank you. Unfortunately, I do not have a copy of the ct scan nor the MRI, both went to the new ENT that I saw last week. Both ENT's were concerned about removing the polyp because of how close it is to the olfactory nerve and the potential for scarring. My ENT did some debrieding a few weeks ago and took out a lot of stuff, but he did not touch the polyp. My ENT does not believe there is any infection in my sinuses based on the endoscopies . ANd I Have used vancomycin twice(MRSA that was found on a culture) and was on levaquin twice as well. I believe you are right that the odor may be coming from the swelling around the polyp and the obstruction of airflow. What is a hypertonic saline wash? I have been using the packets mixed with saline and baking soda. I have also added the budesonide to the washes. Is an inverted papiloma serious? Would that be seen on the CT scan or endoscopy? Both ENT's say it looks like a polyp...second one was just concerned about the location that you don't often see them there. Is is possible to remove the polyp with limited scarring? They both don't seem to think so. I wish I had the images to share.
doctor
Answered by Dr. Sumit Bhatti (18 hours later)
Brief Answer:
Details as discussed below:

Detailed Answer:
Hi,

Thank you for writing back.

1. Hypertonic saline washes contain 2-3% saline as compared to the regular 0.9% saline solution.

2. It should be possible to remove the polyp without excessive scarring.

3. Some images or Scan reports would be useful.

4. Inverted papillomas are locally aggressive tumours and can be managed well.

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

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

Answered : 2662 Questions

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What causes persistent bad smell in nose while treating sinus?

Brief Answer: Try hypertonic saline nasal washes with added steroid. Detailed Answer: Hi, Thank you for your query. 1. If you can upload a few CT Scan and Endoscopic images, it will help me to understand the location extent and the size of this nasal polyp. 2. The smell in the nose can be attributed to local inflammation and round the polyp, fungal or bacterial infection, obstruct of airflow to the olfactory mucosa and previous surgery. 3. Hypertonic saline nasal washes should help. You can add half the contents of a a budesonide respule in the nasal wash. 4. An endoscopic biopsy or polyp excision with a debrieder (if medical treatment does not work) should be a simple procedure. An inverted papilloma should be ruled out. I hope that I have answered your query. If you have any more questions I will be available to answer them. Regards.