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Sinusitis and post nasal drip
Sinusitis does not directly cause bad breath. However, chronically inflamed sinuses do produce large amounts of mucous of varying thickness, which tends to drip down the back of the throat, coating both the throat and the back of the tongue. This condition is called post nasal drip. Mucus is made up of interlinked strands of protein, and anaerobic bacteria have a field day breaking down these proteins into foul smelling and sour tasting sulfur compounds. In addition, the thick secretions cling to the back of the throat causing the patient to want to swallow. Unfortunately, the mucous remains attached to the back of the throat leaving the patient feeling obsessed with swallowing.
The cure for post nasal drip is to treat the condition causing it.
The common cold, flu or allergy often cause post nasal drip. Ultimately, the cure for post nasal drip due to these conditions is to wait them out and when the condition cures itself, the post nasal drip stops as well. There are, however measures that a patient can take to reduce or eliminate post nasal drip while these conditions persist. General measures to reduce the discomfort and bad breath involve taking three drugs in combination:
Sudafed is a decongestant that is available over the counter. It can be purchased in timed release capsules, and it opens the sinuses while reducing the amount of mucous secreted.
Guaifenesin is a fairly safe drug that thins out the mucous that is produced and makes it easier to swallow. Guaifenesin is available over the counter in Robitussin® or a generic equivalent. Mucinex is another great source for large doses of this safe drug and it is now available over the counter.
An antihistamine like Benedryl® is a good antihistamine for nighttime use since it makes the patient sleepy. One of the newer non-drowsy antihistamines like Allegra® and Claritin® is appropriate for daytime use. Antihistamines help to relieve itchy, watery eyes and the tendency to sneeze. They also reduce the irritation in the sinuses which may be causing the post nasal drip in the first place.
One additional suggestion: The feeling that you always want to swallow the mucous in the back of your throat is quite irritating and distracting. It is possible to remove the mucous at the back of the throat simply by eating a piece of bread, a stalk of celery, or any other bulky food. The mucous will be swept down the esophagus when you swallow the food. If you have chronic problems with this condition, keeping a stalk of celery on the bedside table can make the night more peaceful.
Sinus infections cause the sinuses to produce thick, infected mucous which has a bad odor even before it is metabolized by the bacteria in the mouth. Sinus infections are best cured using an appropriate antibiotic. The standard antibiotic used for upper respiratory infections of all sorts in patients who are not allergic to penicillin is amoxicillin. If the patient is allergic to penicillin, then clindamycin, Biaxin® or Zithromax® are the drugs of choice. While the patient is under treatment for the sinus infection, it is advisable for him/her to take Sudafed and guaifenesin to keep the sinuses open and to create enough thin mucous to help keep them clear.
Tonsillitis means an infection of the tonsils. Infections of the tonsils are generally caused by streptococcus (as in strep throat). The tonsils become red and inflamed while small white colonies of the strep organism are found in the tonsillar crypts, which are little indentations found on the surface of the tonsils (Click the image at the right for a closer look). Patients with strep throat or tonsillitis tend to have bad breath (ozostomia) until the infection is cleared up. The drug of choice for patients who are not allergic to it is penicillin. For patients who are allergic to penicillin, clindamycin, Zithromax® or Biaxin® are the drugs of choice.
People with chronic sinusitis and post nasal drip may develop tonsilloliths which are tiny, white, foul smelling stones which lodge in the tonsillar crypts. Sometimes a tonsillolith can be pried out of the surface of the tonsil with a pencil or other small pointed instrument leaving what looks like a little “hole”, but is, in fact, simply the tonsillar crypt in which it formed originally. Tonsilloliths sometimes give the feeling of something lodged in the throat. They can also contribute to bad breath. Some people have chronic problems with tonsilloliths. The only sure treatment for chronic tonsilloliths is removal of the tonsils. The operation is performed by an ear, nose and throat specialist (ENT) and is fairly simple and safe. The operation causes a very serious sore throat for two weeks post-op, but the benefit is that the patient suffers no more tonsillitis or tonsilloliths. Short of removing the tonsils, the bad breath can be treated by gargling with a 3% solution of hydrogen peroxide or Peridex® mouth wash which is available by prescription from your dentist or physician. The use of guaifenesin and Sudafed to lessen the post nasal drip is also effective.
Stomatodysodia is bad breath caused by outright disease processes in the lungs. These include infections, bronchitis and pulmonary abscess, as well as chronic problems like tuberculosis, pneumonia, emphysema, and lung cancer. It also includes odors from stagnant mucous accumulated in the lungs due to prolonged bed rest, as well as stagnant cigarette smoke embedded in it. People with any of these conditions generally already know they have them, and their bad breath is at least partly from their disease condition.
Halitosis is a term invented in 1921 by the Listerine company. It means bad breath stemming from systemic metabolic conditions. Chemicals from systemic disease conditions are carried to the lungs via the bloodstream. In other words, the odor comes from chemicals excreted through the lungs. Halitosis is also the term used to describe mouth and throat odor due to vomiting. There are two types of halitosis:
- Physiologic halitosis is of a temporary nature and happens when a patient eats certain aromatic foods such as herbs, spices, certain cold cuts, curries, onions, garlic, radishes, turnips and leeks, or drinks certain types of liquids such as wine, brandy, whisky, liqueurs, beer, tea and coffee. Foods such as these are the most common source of transient (temporary) bad breath, and the cure for physiologic halitosis is simply to avoid aromatic foods, or to wait out the effects.
- Pathological halitosis originating in the lungs is caused by the release of chemicals from disease processes elsewhere in the body, and carried to the lungs by the bloodstream. This type of halitosis is not easily reversible and tends to persist without treatment. The best way to treat the bad breath caused by pathological halitosis is to treat the underlying condition. The most common conditions which cause pathological halitosis are as follows:
- Diabetes–Uncontrolled diabetes causes the accumulation of abnormal metabolites in the bloodstream, and these are excreted through the lungs. They include ketones such as acetoacetic acid, hydroxybutyric acid and acetone.
- Uremia–Urine in the bloodstream caused by kidney failure.
- Gastritis–Inflammation of the lining of the stomach.
- Gastric ulcer–actually localized bacterial infections in the lining of the stomach.
- Liver disease, or Hepatitis–In particular, Fetor Hepaticus,which is bad breath caused by chronic liver failure. Also known as “breath of the dead,” Fetor hepaticus is a condition seen in portal hypertension where an incompetent liver allows mercaptans to pass directly into the blood stream, and finally into the lungs where they are exhaled. It is a late sign in liver failure. The breath has a sweet, fecal smell.
- Pathological halitosis originating in the stomach is caused by conditions which produce chronic vomiting. In this case, the origin of the bad breath is the stomach, but the real culprit is the vomit which coats the throat and oral structures and stagnates producing foul odors.
- Acid Reflux Disease (ARD–Formerly known as GERD)–This is generally controlled using H2 blockers like Tagamet, Zantac or Pepsid.
- Pyloric Stenosis–This is a developmental condition found in infants which causes vomiting, and is corrected surgically.
- Any condition which causes chronic vomiting can potentially cause pathological halitosis. This includes migraine headaches, morning sickness, food poisoning, food allergies, bulimia, alcoholism, certain medications and chemotherapy in cancer patients.