Unpleasant Odors from the Nose: Causes and Solutions - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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It may be sinusitis; let's try medication for treatment.
Understanding sinusitis: What are the sinuses and their functions? The sinuses are located within the skull and nasal cavity.
There are four types of sinuses, paired on both sides: the maxillary sinuses are located on either side of the nose, the ethmoid sinuses are above, the frontal sinuses are in the upper front, and the sphenoid sinuses are located in the upper back (as shown in the diagram).
The sinuses are lined with a thin membrane that has tiny cilia.
The movement of these cilia helps to transport secretions from the sinuses through drainage openings into the nasal cavity.
Since the nasal cavity is constantly exposed to the external environment and the sinuses are connected to it via drainage openings, when the nose becomes infected with bacteria, the increased secretions and swelling of the mucosa can lead to nasal congestion.
At this point, the drainage openings of the sinuses may become blocked, preventing the expulsion of invading bacteria and secretions, resulting in sinusitis.
Causes and long-term bothersome symptoms: Sinusitis often results from an incomplete recovery from a cold, leading to recurrent infections, and can be classified into acute and chronic forms.
Patients with acute sinusitis typically experience nasal congestion, purulent nasal discharge, and tenderness around the nasal bridge, forehead, and under the eyebrows, along with possible fever, headache, fatigue, and swelling around the eyes.
Chronic sinusitis often arises when acute sinusitis is inadequately treated or is associated with conditions such as allergic rhinitis, nasal polyps, deviated septum, or hypertrophic rhinitis, which obstruct the airflow in the nasal cavity and sinuses.
Consequently, the infected sinuses may become a site for continuous bacterial proliferation, leading to chronic sinusitis, characterized by nasal congestion, purulent nasal discharge, postnasal drip, cough, feelings of heaviness or dizziness upon waking, difficulty concentrating, and memory impairment.
Treatment: Adolescents are particularly susceptible to sinusitis due to incomplete physical development, and nasal discomfort is often overlooked by parents, delaying treatment.
Therefore, when experiencing the aforementioned symptoms, it is important to consult an otolaryngologist for appropriate treatment.

For the treatment of acute sinusitis, the general principles involve medication and local treatment, and if necessary, maxillary sinus puncture and irrigation to promote nasal and sinus drainage, with complete recovery expected within three weeks.

For chronic sinusitis, surgical intervention is often required for a definitive cure, typically recommended after the age of 14.
Patients with allergic rhinitis, nasal polyps, or deviated septum must also be addressed simultaneously to ensure effective surgical outcomes.
Endoscopic sinus surgery, combined with ethmoid nerve anesthesia, has shown good results, with advantages including minimal bleeding, reduced pain, and clear surgical visibility, allowing the surgeon to meticulously remove pathological tissue while avoiding unnecessary damage.

Surgical treatment for chronic sinusitis is akin to reconstructing a new sinus, requiring proper care.
The new and healthy tissue in the sinuses will take about three months to fully develop post-surgery, necessitating regular local treatment and, if needed, medication until the new tissue is completely formed.
Following an additional six months of recovery, the entire treatment can be considered complete, alleviating the distress caused by sinusitis.

Dr.
Yeh Da-Wei, Director of the Otolaryngology Department, Hsinchu Hospital.

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Reply Date: 2007/10/08