There are plenty of reasons why it might seem like something always smells off. Maybe you haven’t inspected your fridge in a while or there’s something funky lurking in one of your garbage cans. Perhaps you’re the funky something lurking.
Once you’ve ruled out the usual culprits and the bad smell still won’t quit, this could be a sign it’s coming from the inside of your nose. “Patients present to the ENT (ear, nose, and throat) physician every day with complaints of a foul odor,” says Chris Thompson, M.D., an ENT specialist with Providence Mission Hospital in Southern California.
It turns out there are a variety of health issues related to the sinus area that can trigger a rotten smell in your nose—most of which are temporary and not a sign of something more serious.
But if the bad smell in your nose has been hanging around for over a month, is getting worse, or is associated with red flag symptoms like fever or whole body chills, severe facial swelling or pain, vision changes or eye swelling, severe nose bleeds, and changes in mental status, check in with your doctor or an ENT specialist, stat.
“These symptoms may point to a severe or life-threatening infection or disease process,” says Matthew Kim, M.D., an ENT specialist at Westchester Medical Center in New York.
As for what might be causing that bad smell in your nose? Read on for the likeliest suspects, according to doctors.
1. Postnasal drip
Here’s a fun fact: The nose typically makes about one liter of mucus per day. “We swallow it and are unaware of its presence,” says R. Peter Manes, M.D., a rhinologist and sinus surgeon with Yale Medicine in New Haven, Connecticut. “When it thickens, which happens due to a variety of conditions, it can become bothersome and produce a detectable odor.”
Postnasal drip—the feeling of mucus draining in the back of your throat—can strike because of conditions like allergies, colds and flu, hormonal changes, and dehydration. Medications, such as birth control pills and meds for high blood pressure, can also produce increased mucus.
“Nasal saline irrigations, either with a neti pot or an irrigation bottle, can often alleviate the feeling and odor of the mucus,” says Dr. Manes. The same goes for nailing down the cause of your postnasal drip and then doing things to counteract it (avoiding allergy triggers, taking a decongestant, drinking more water).
Not only can a sinus infection increase the thickness of mucus, it can also “cause mucus to stagnate in the nose, leading to a worsening smell,” says Dr. Manes. Most sinus infections are viral (a la the common cold) and respond well to home remedies, such as decongestants and saline irrigations.
“When an infection lingers, it may represent a bacterial infection and may require a visit to the doctor for evaluation and treatment,” says Dr. Manes, in which case your doctor will prescribe a round of antibiotics to alleviate the infection and decrease the foul smell.
3. Nasal vestibulitis
“Some people can experience a bad smell in their nose from bacterial overgrowth in the anterior nostrils (the front part of your nostrils), called nasal vestibulitis,” says Dr. Thompson. Frequently picking or blowing your nose are the most common ways the infection can manifest, which can result in pimples at the base of nose hairs and sometimes crusts around the nostrils.
If the infection is mild, it can most likely be treated with the topical antibiotic bacitracin, which is available over-the-counter and may need to be applied for several weeks. More severe infections may require a round of oral antibiotics from your doctor to clear things up.
4. Nasal polyps
Polyps are noncancerous growths that form in the nose, usually as a result of chronic inflammation (say, asthma, allergies, infections). “In addition to nasal obstruction and facial pressure, they can affect your sense of smell and taste,” says Dr. Manes. “They may decrease your sense of smell or lead you to experience a foul smell in your nose.”
Treatments are wide-ranging, from topical nasal steroids (Flonase, Nasacort, and Rhinocort are available over-the-counter; Nasarel, Nasonex, Veramyst and the like require a prescription) to sinus surgery.
“If you have a concern about nasal polyps, evaluation by a physician can be helpful, as they’re able to look directly into your nose to see if they’re there or not,” says Dr. Manes.
Usually the result of an upper respiratory infection, phantosmia is a technical term for phantom smells, where a person smells odors that aren’t really there or a normally pleasant odor is perceived as unpleasant. “Basically, the brain is sending wrong signals of an olfactory hallucination where an odor isn’t present, due to inflammation or inaccurate neuron function,” says Dr. Thompson.
Phantosmia typically resolves on its own with time—but because it can also be caused by a head injury or neurological condition, such as a brain tumor (though this is very rare), it’s best to check in with your doctor to root out the underlying cause if it sticks around.
“If evaluation by an ENT and neurologist is unremarkable, some phantosmia can be diagnosed as a migrane variant,” says Dr. Thompson.
Some people might have a large fungal ball in their sinus, known as a rhinolith, and not even know it. “Sometimes the fungal ball can be present for years,” says Dr. Thompson. This sneaky mass is usually the result of a foreign body that’s unknowingly lodged in the nose, such as small stone fragments, grains, seeds, or dried secretions, that then calcify and gradually increase in size.
“The fungal ball can get super-infected with bacteria, leading to a foul odor,” says Dr. Thompson, and it’s these symptoms that lead the person to seek out a consult with an ENT. From there, the rhinolith is discovered through an exam, which typically involves a nasal endoscopy or CT scan.
7. Tooth decay
Cavities, gum disease, and dry mouth give way for bad breath bacteria to set up shop in your mouth for the long haul. (The deeper pockets from gum disease, for example, can give the bacteria places to hide that brushing and flossing won’t always catch.) “That same buildup of bacteria and tooth decay can cause a foul smell in the nose,” says Dr. Manes.
There are plenty of things you can do to alleviate your bad breath, such as diligently brushing twice a day and flossing once a day, drinking enough water, and cutting back on caffeine—but if you find your bad breath still won’t quit, a visit to your dentist can help you get to the bottom of what’s going on.
8. Digestive issues
Conditions like acid reflux and GERD, which involve stomach acid splashing back up into the esophagus, can lead to a metallic taste and smell, says Dr. Thompson. Doing what you can to alleviate the digestive drama—eating three to four small meals a day instead of two to three larger ones, avoiding food and drinks for at least two hours before bedtime, and popping the occasional antacid—should also help to alleviate the bad smell in your nose.
But if the reflux and subsequent bad smell in your nose doesn’t get any better, a consult with an ENT can help be helpful in turning things around.
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