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Medical Forum / Diseases and Disorders / Sinusitis / October 2005Improving...but the breath
I've been on augmentin for 10 days, am doing nasal washes 2x daily and finishing off with Rhinocort steriod spray. I've seen marked improvement in the following: my throat doesn't hurt as much in the morning decreased pnd pnd is much thinner, no more glob in the throat feeling i can breathe much better mucus from the nose is either crystal clear or milky white BUT... my breath is apparently still horrible. I can't smell myself 99% of the time, but every once in awhile when all the stars align, I catch a fleeting whiff of grossness from my throat. I also notice if I'm in a small room or if I've sat in an area for a long time, the air takes on the stale fart odor. Lastly, I still get very strong reactions from people when I talk to them. In other words, I'm positive my breath still reeks. My ent said my tonsils are tiny so she ruled out any problems with them. Sometimes I feel it's safe because I haven't had any pnd for awhile and I'll talk freely with someone and from the way they react, I know I was wrong. Yes, have proper and diligent oral care, dentist and ent both said I've a very clean tongue, no tonsil problems, decreased pnd, drink water like it's going out of style, avoided onion and garlic for the longest time, etc. Why hasn't the bad breath followed suit? I have acid reflux (Gerds) and I get that smell sometimes, it comes up from my stomach. It is from reflux , almost a sour smell. Especially if my stomach is empty, like in the morning. shirley Yes, I'm beginning to wonder if I actually have a sinus infection or if it's really acid reflux. The ENT asked me gerd-related questions and did an endoscope. She didn't mention anything about reflux after that, so it makes me wonder if she thinks it's not gerd-related. I'm still leaning towards the sinus only because I had two cases of acute sinusitis a decade ago and it seems like I've chronic sinusitis ever since. My only doubts are that my mucous from irrigation is crystal clear (shouldn't infection mean green mucous?), that the stench seems to be coming from deep down my throat and even though my pnd has lessend, the smell hasn't. So these couple of things make wonder if it's really gerd-related. I do not have the usual gerd symptons either though. I do burp a bit but that's about it. Oh, the smell isn't sour. More metallic-tasting and my mom likened the odor to flatulence. Like I wrote earlier, I can fill up a small room or the surrounding area that I am in. >Yes, I'm beginning to wonder if I actually have a sinus infection or if >it's really acid reflux. The ENT asked me gerd-related questions and >did an endoscope. She didn't mention anything about reflux after that, >so it makes me wonder if she thinks it's not gerd-related. Ask her to look at the larynx for stains indicating reflux. Easy to do if she has not done so already. >I'm still leaning towards the sinus only because I had two cases of >acute sinusitis a decade ago and it seems like I've chronic sinusitis [quoted text clipped - 10 lines] >odor to flatulence. Like I wrote earlier, I can fill up a small room >or the surrounding area that I am in. Since last writing, I definitely have had reflux. I am hoping that it is temporary and related to my augmentin use. I'll finish my prescription on Tuesday and hopefully, the gassiness, burping, heartburn and worse of all, the refluxing will taper off. I will ask the ENT to check as I think I may have had the 'silent' form of reflux for awhile and it may be the basis of my 'sinus infection'. A friend very kindly told me that my breath was fine when we went out last night save for one moment while in the car when she could caught a whiff of something foul coming from my way. It reinforces belief that my problems are reflux-related. Don, I did a search on 'reflux' and read some of your posts on your mild case of gerd. It seems you have been able to manage the problem by making some simple lifestyle changes. Have they continued to work? Did you have the same problem with the odor and if so, has it been resolved? I've noticed a couple of times when I've smelled the food I have just eaten and that seems to be refluxing. I imagine that's what people can smell. On the one hand I'm relieved to know that my breath is fine MOST of the time, but it's depressing to know that at random times, a foul odor makes its way out of my mouth. >Since last writing, I definitely have had reflux. I am hoping that it >is temporary and related to my augmentin use. I'll finish my >prescription on Tuesday and hopefully, the gassiness, burping, >heartburn and worse of all, the refluxing will taper off. I will ask >the ENT to check as I think I may have had the 'silent' form of reflux >for awhile and it may be the basis of my 'sinus infection'. Maybe but I have also neen told by an expert that mild reflux alone will not account for sinusitis. Then tends to match my current opinion. Opinions do differ though... >A friend very kindly told me that my breath was fine when we went out >last night save for one moment while in the car when she could caught a [quoted text clipped - 4 lines] >mild case of gerd. It seems you have been able to manage the problem >by making some simple lifestyle changes. Have they continued to work? Yes I would say so. It comes down to eating less bulk, less frequently, (no snacks) and not eating close to bed. I tend to eat a very high bulk vegetarian diet. >Did you have the same problem with the odor I think I know what you are referring to but it is not constant with me. >and if so, has it been >resolved? [quoted text clipped - 4 lines] >MOST of the time, but it's depressing to know that at random times, a >foul odor makes its way out of my mouth. It may not be as noticeable as you fear. Well it's noticeable enough for a friend to let me know about it. Two weeks ago it was enough to fill up a small room. I don't know if that wasinfection-related or not. I haven't gotten really strong reactions this week even though the reflux has been at its worst. Go figure. What are bulk foods? Rice, legumes, etc? I'm not vegeterian, but do like high fiber foods. >What are bulk foods? Rice, legumes, etc? I'm not vegeterian, but do >like high fiber foods. Yes fiber and bulk would be the same. I certainly would not avoid them though.... >A friend very kindly told me that my breath was fine when we went out >last night save for one moment while in the car when she could caught a >whiff of something foul coming from my way. It reinforces belief that >my problems are reflux-related. Does a temperature or humidity change (e.g., going to or from a cold air-conditioned room) sometimes make it worse? If so, you may have an one or more infected sinuses with ostia often swollen shut, but periodically they open a bit and you get some foul drainage. Do you tend to have dry mouth? > Does a temperature or humidity change (e.g., going to or from a cold > air-conditioned room) sometimes make it worse? If so, you may have an > one or more infected sinuses with ostia often swollen shut, but > periodically they open a bit and you get some foul drainage. Yes, I remembered a couple of weeks ago when I first started my antibiotics that I had forgotten my sweater and I was in AC rooms, my PND worsened and a couple of times I caught a strong whiff of odor. I distinctly remembered one incident where I was talking to a friend and as I was replying, I had my mouth open, post-nasal drip just sliding down and I could smell it very well. It was a like a nanosecond, but it has been one of the few times I have been able to notice the odor. When my friend told me about when she could smell my bad breath, I didn't notice it myself. So if I'm not getting discolored mucous when I'm doing my nasal washings, it may be because the ostias are swollen shut? I am getting clear mucous though. > Do you tend to have dry mouth? Yes, one of the big mysteries because I must drink up to 100oz of water everyday. As I have been able to breathe through my nose (right), I'm trying to not mouth-breathe as much. That's helped, but I still feel like my mouth and throat are dry. My lips get dried out quickly too. >> Does a temperature or humidity change (e.g., going to or from a cold >> air-conditioned room) sometimes make it worse? If so, you may have an >> one or more infected sinuses with ostia often swollen shut, but >> periodically they open a bit and you get some foul drainage. >Yes, I remembered a couple of weeks ago when I first started my >antibiotics that I had forgotten my sweater and I was in AC rooms, my [quoted text clipped - 5 lines] >When my friend told me about when she could smell my bad breath, I >didn't notice it myself. >So if I'm not getting discolored mucous when I'm doing my nasal >washings, it may be because the ostias are swollen shut? I am getting >clear mucous though. If you had something going on in, e.g., one sinus and its ostium was swollen shut, and you irrigated, you could still get clear mucus from the others, I would think. Some people have reported good luck using the Grossan with cold water, or maybe cold water followed by warm to avoid possible rebound effect. >> Do you tend to have dry mouth? >Yes, one of the big mysteries because I must drink up to 100oz of water >everyday. As I have been able to breathe through my nose (right), I'm >trying to not mouth-breathe as much. That's helped, but I still feel >like my mouth and throat are dry. My lips get dried out quickly too. Dry mouth probably goes along with dry nasal membranes. Which means bacteria aren't getting washed down into the stomach as they should be. I don't think there's a one-for-one correlation between dry-mouth and overall hydration -- for example, you can get virtually instant dry mouth if you suddenly become nervous. I think it's possible for a collection of problems to interact and cause a very noticeable symptom (i.e., halitosis) that isn't tied to any single underlying problem. For example, you may have a few rough spots or places in your teeth that collect debris, but because your oral hygiene is good, you don't get decay and the dentist doesn't notice them. But, interacting with dry mouth, they may contribute to halitosis fairly quickly. Similar, intermittent drainage from a low-level infection in one sinus collects more often in the back of the throat and on the tongue because of the dry mouth. Have you tried chewing xylitol gum more or less constantly for a day to see if that might help? >> Does a temperature or humidity change (e.g., going to or from a cold >> air-conditioned room) sometimes make it worse? If so, you may have an [quoted text clipped - 7 lines] >as I was replying, I had my mouth open, post-nasal drip just sliding >down and I could smell it very well. If you have an infected sinus then you may be able to smell it when it opens up a bit. I have had that from time to time. If you are smelling it more recently, that can actually be good because your sinus(es) may be opening up and starting to drain. All in all, I would think that that is a more likely than the reflux hypothesis. You say your condition is improving, so I sespect that that is indeed what is happening. It is the same with rotten drainage. People think it is bad, but it is actually good because the sinuses are finally draining. Probably some of them were sealed off up to that point, or it would bever have come to that condition in the first place. If so, just wait and when/if it drains completely the smell will go away. Try to avoid allergens auch as dust and mold. These are usually what cause sinusitis in the first place. An ENT should be able to look at the ostia with an endoscope. If you have an ENT who does not bother doing that on visits, switch to a different ENT. I have found that the good ones do it on every visit. A major University medical center is a good place to look.... > If so, just wait and when/if it drains completely the smell will go away. My antibiotics end tomorrow. Will nasal washing be enough to facilitate the drainage without medication? On the other hand, I don't think my body can take any more of the antibiotics. Hopefully this is not because I have just gotten used to the odor, but I think the frequency of the odor has lessened. I have been able to have normal interactions with people without major reactions this past week. > An ENT should be able to look at the ostia with an endoscope. If you have an > ENT who does not bother doing that on visits, switch to a different ENT. I > have found that the good ones do it on every visit. A major University > medical center is a good place to look.... I'm a student at a major university and am using its hospital. I've only seen the ENT once and she did do an endoscope. She looked around and only said that there were obvious signs of inflammation in my nasal passages along with PND. But nothing about the ostia. >> If so, just wait and when/if it drains completely the smell will go away. >> >My antibiotics end tomorrow. Will nasal washing be enough to facilitate >the drainage without medication? I think so as long as the cycle does not start over again by allergen exposure, flu, or whatever. Many ENT's (and primary care physicians too) would suggest using prescribed Nasonex or Flonase steroid spray daily at least fhroughout the seasons in which you have allergies, if any. There is little downside to doing so - they are not addictive (as Afrin is) or as drying as antihistamines are. You might want to use it for at least a few months to be on the safe side. > On the other hand, I don't think my >body can take any more of the antibiotics. [quoted text clipped - 3 lines] >have normal interactions with people without major reactions this past >week. That is my guess. It will probbaly die off quite rapudly as long as the cycle does not start over. >I'm a student at a major university and am using its hospital. Good. > I've >only seen the ENT once and she did do an endoscope. She looked around >and only said that there were obvious signs of inflammation in my nasal >passages along with PND. But nothing about the ostia. Well it can be subtle. Inflammation is inflammation in any case and probably would affect the sinuses. I think it just happened again... I'm in an AC computer lab and have been here a couple of hours. A faint whiff of something, followed by a very strong flatuence odor and I then swallowed PND. Does this sound like classic drainage? Also, why the !@#$% does it smell like flatuence?! So this tells me that if I had an infection, 20 days of augmentin didn't work completely. Kinda makes sense now...at the beginning I felt like my breath was foul all the time and it was because I had loads of PND in my throat. Now I feel my breath is fine most of the time and have these random episodes because I still get the occassional PND. What is the reasoning behind cold/warm washing and rebounding? I'll try it if it means more effective drainage of my sinuses. And I do use the Grossan irrigator and Rhinocort Acqua, twice a day. Any other method to coaxing the ostia to open up? All of this is going in a memo to the ENT... >I think it just happened again... > >I'm in an AC computer lab and have been here a couple of hours. A >faint whiff of something, followed by a very strong flatuence odor and >I then swallowed PND. Does this sound like classic drainage? Also, >why the !@#$% does it smell like flatuence?! Hmmm. And how do you relate to your professors ? (sorry, couldn't resist). Yes, I think that's a typical scenario that many of us have experienced. >What is the reasoning behind cold/warm washing and rebounding? I'll >try it if it means more effective drainage of my sinuses. And I do use >the Grossan irrigator and Rhinocort Acqua, twice a day. Any other >method to coaxing the ostia to open up? Cold, either air or water, shrinks the tissues, which should normally enlarge the ostia and facilitate drainage. Unfortunately, the body responds by rushing blood to the cold area and this leads to rebound swelling. Many people, myself included, have found that a warm rinse, after exposure to cold, seems to stop this from happening. Afrin is similar. It shrinks the tissues, you drain, but then the body rebounds and you clog up again, remaining critters in your sinuses multiply and you often end up worse than before. Some people have found that using Afrin, waiting a few minutes, then irrigating, cleans out the area and minimizes rebound. As usual, YMMV -- some things work for some of us some of the time. >All of this is going in a memo to the ENT... On 10/10/05 12:20 AM, in article pr4kk1906p9cddunmsbcoeo6tbhr56fa38@4ax.com, >>> Does a temperature or humidity change (e.g., going to or from a cold >>> air-conditioned room) sometimes make it worse? If so, you may have an [quoted text clipped - 36 lines] > have found that the good ones do it on every visit. A major University > medical center is a good place to look.... When the allergy kicks in, then the temperature regulating mechanism of the body malfunctions and chilling will bring on symptoms. Very important to drink hot tea before getting out of bed in AM to avoid AM sneezing and hacking. > When the allergy kicks in, then the temperature regulating mechanism of the > body malfunctions and chilling will bring on symptoms. > Very important to drink hot tea before getting out of bed in AM to avoid AM > sneezing and hacking. All my life, I always wondered why I could sleep soundly during the night, but then start sneezing minutes after I got out of bed in the morning. Thanx, Dr. G, for this explanation.  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > When the allergy kicks in, then the temperature regulating mechanism of the > body malfunctions and chilling will bring on symptoms. > Very important to drink hot tea before getting out of bed in AM to avoid AM > sneezing and hacking. I'm not sneezing or hacking though. I sneeze maybe once a day, if that. Maybe my only sympton of the malfunctioning is the release of pnd? I haven't read throught this whole post so someone may have asked already. Have you been checked for GERD? You don't necessarily have to have heartburn to have GERD. I was recently diagnosed with this after having a persistent sore throat and having some clear mucous/acidy taste in my throat which I thought was PND. I never had heartburn or stomach symptoms. Maybe the stomach acids could be causing some odor. Just a theory as I think my breath was/is ok. I was surprised to find out that GERD presents itself differently. I had incorrectly thought you had to have heartburn. I had a barium upper GI xray to confirm the diagnosis. You could try a 14 day course of prilosec OTC and see if it does anything for you (or better yet ask your doctor if this is a possibility). Here's a link with some additional things to check: http://www.doctorhoffman.com/halito2.htm |
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