12 Reasons That Bad Smell in Your Nose Isn’t Going Away, According to Doctors
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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. 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.
Causes for bad smell in your nose
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).
2. Sinusitis
Sinusitis, or a sinus infection, is the inflammation of the tissues in your sinuses (spaces in your forehead, cheeks and nose usually filled with air), explains Benjamin Tweel, M.D., medical director for the department of otolaryngology at Mount Sinai Health System. Sinus infections can cause “facial pain, a stuffy or runny nose, sometimes a fever and other symptoms, like foul smell.”
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 soft, painless, noncancerous growths on the lining of your nasal passages or sinuses, explains Dr. Tweel. “They hang down like teardrops or grapes.” Polyps typically result from chronic inflammation and are associated with asthma, recurring infection, allergies, drug sensitivity or certain immune disorders, he adds.
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 and Nasacort 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.
5. Parosmia/Phantosmia
Parosmia describes an alteration of the sense of smell, says Dr. Tweel. This encompasses phantosmia, which is a “phantom smell,” which is thought to be an illusion in the brain or smell nerves, he notes.
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 migraine variant,” says Dr. Thompson.
Parosmia also includes distortion of the sense of smell, notes Dr. Tweel. “This has been seen in patients who have or have recovered from COVID.” Usually, these patients will have lost their smell, then may have smell alterations as their sense of smell recovers and may often notice that foods taste different than they used to, he adds.
6. Rhinoliths
Sometimes a rhinolith, a stone present in the nasal cavity, 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 [rhinolith] can get infected with bacteria, leading to a foul odor,” says Dr. Thompson, and it’s these symptoms that lead the person to seek out a consultation with an ENT. From there, the rhinolith is discovered through an exam, which typically involves a nasal endoscopy or CT scan.
7. Tooth decay
Tooth infections, cavities, gum disease, and overall poor oral hygiene can all lead to a bad smell in the nose and a bad taste in the mouth, says Dr. Tweel. “Plaque and bacteria have an odor and can travel through the mouth and reach the sinuses. Tooth decay traps bacteria that release gases that can also produce an unpleasant odor.”
There are plenty of things you can do to alleviate the bad smell coming off your breath and inside your nose, 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.
Some more serious conditions can also be related to a bad smell in the nose, such as diabetes, liver disease and kidney disease, notes Dr. Tweel. So 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 and to rule out any other serious health concerns.
9. Nasal foreign body
This is a common cause in children, and is rare in adults, says Dr. Tweel. “However, there have been reports of longstanding nasal foreign bodies in adults which were traced back to their childhood.”
A nasal foreign body, like a bead, a toy, or food, will usually show up with foul-smelling nasal mucus on one side, Dr. Tweel explains. Consequently, a child with foul-smelling mucus on one side needs to go to their doctor or an ENT specialist, he adds.
10. Tumors
While a fairly rare cause of a foul nasal odor, tumors in the nasal cavity are often accompanied by a foul smell, says Dr. Tweel. But don’t jump to conclusions just yet: Typically if a tumor is the culprit behind the bad smell, “there will be other symptoms, such as bleeding, nasal obstruction or pain.”
11. Autoimmune disease
Another rare cause of a bad smell in the nose, some autoimmune diseases can trigger a bad smell in your nose, says Dr. Tweel. “Conditions in this category, such as granulomatosis with polyangiitis (formerly known as Wegener disease) can lead to severe nasal crusting as a consequence of damage to the tissue within the nose.” Patients with these conditions will often have large crusts that come out of the nose and/or bleeding, he notes.
12. Drug use
Nasal ingestion of cocaine or other drugs (for instance, crushed pills) can lead to decay and necrosis of the tissue inside the nose, says Dr. Tweel. “This tissue then accumulates dried mucus and bacteria and can often have a foul odor.”
How can you prevent having a bad smell in your nose?
For most people, there is no preventative hygiene that is needed to prevent a bad smell in the nose, says Dr. Tweel. “However, patients who have chronic conditions, such as chronic sinusitis, or nasal crusting, may use nasal saline irrigation regularly as part of preventative therapy,” he says.
When to see a doctor about having a bad smell in your nose
If the foul smell continues for over a month, it’s time to see a doctor, says Dr. Tweel. “You may try nasal saline irrigations with a sinus rinse or neti pot (I like a NeilMed Sinus Rinse) in the meantime.” If the foul smell is accompanied by other symptoms such as bleeding, obstruction or crusting, that is also a reason to see your doctor or an ENT specialist sooner rather than later, he notes.
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