Q. Halitosis is ruining my personal life and career. Please help.

Answered by
Dr. Shyam Kalyan N
and medically reviewed by iCliniq medical review team.

Hi doctor,

I have suffered congestion, brain fog, and extreme halitosis for five years and I have extremely thick mucus (liquid) with air bubbles in it. One side of my head is worse than the other. I have been to two ENTs. I have had CT scans of brain and sinus and they are all clear. Could it be Sjogren's disease, salivary gland disease, and adenoid disease? I have had the yellow tonsil stones, but it seems like they came from my throat. My throat always smells like tonsil stones, and sometimes like contaminated saliva. I have lost jobs and relationships over this. This has ruined my life. Please help. I am currently on Azithromax, but I do not think it is having an effect.

Do you have a question on Post Nasal Drip or Pantoprazole?

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Dr. Shyam Kalyan N

MBBS (MADRAS MEDICAL COLLEGE)., DLO., CERTIFICATE IN ALLERGIC RHINITIS MANAGEMENT., DNB
Allergy Specialist Otolaryngology (E.N.T)

Hello,

Welcome to icliniq.com.

  • Is the problem more on one side? If so, which side is it? Do you have any nose block or reduced sense of smell? Any facial pain or headache or sinus pressure? Is there any postnasal drip?
  • Is the halitosis worse after taking any particular food or drink? Do you have any issue with your teeth? When was the last time you visited a dentist? Is the mucus more during mornings?
  • Do you have a sore throat? Is there any difficulty in swallowing? Do the tonsil stones come out regularly? Can you click a picture of your throat and send us in the next query? Do you have a good sleep at night? Do you get eight hours of uninterrupted sleep? Do you have dryness of mouth or mouth breathing or snoring in the night? Have you tried mouth rinses?
  • Can you upload the CT scan images of sinuses and the brain in the next query? Can you share the reports of the other lab tests you have performed? Adenoids can be diagnosed using the CT films and also during an office visit to the ENT if he does an endoscopy of the nose. Do you have consultation papers of the visit? If so, please share them.
  • The details you provide will help us understand the condition better. Since you have been having this problem for a long time, we would like to evaluate using all possible detail.

Do revert back with details and we shall try our best to get you back in form.

For more information consult an ENT otolaryngologist online --> https://icliniq.com./ask-a-doctor-online/ENT-Otolaryngologist

Thank you doctor,

The problem is more on the right side towards where the tonsil is positioned and around the back of my ear. Tonsils are not enlarged visibly, but a liquid is coming from it I think. I have nasal drip all the time. The liquid is not like normal mucus, it is different. I use the neti pot, but it is not helping. Sometimes, I wake up with brain fog and balance problem. I sleep well. I have done dental X-rays as well. Everything from the dental X-rays was good according to the dentists. I do not have nose blocked. But, when this started years ago, my nose was blocked all the time. I was not given a CT film, but a report, which I will attach. I will also send a throat picture.

Dr. Shyam Kalyan N

MBBS (MADRAS MEDICAL COLLEGE)., DLO., CERTIFICATE IN ALLERGIC RHINITIS MANAGEMENT., DNB
Allergy Specialist Otolaryngology (E.N.T)

Hello,

Welcome back to icliniq.com.

  • I have gone through the pictures and reports sent by you (attachment removed to protect patient identity). As you said, they seem unremarkable. Although, I must say I cannot clearly see the inside of the mouth. You should focus on the posterior pharyngeal wall and tonsils. The CT reports are unremarkable.
  • Now, we need to find out the cause for the constant post nasal drip. To rule out any local mucosal cause in the nasal cavities we must do a nasal endoscopy. If you have already done one, can you upload the reports of the same?
  • Are you a diabetic? Do you take any medicines on a regular basis? Are you on any drug that suppresses the immunity?
  • Constant post nasal drip can cause blockage of the eustachian tube leading to ear fullness and decreased hearing. The same can result in one-sided facial pressure, heaviness, and pain. However, such a thing should have come out clearly with a CT scan.
  • I would suggest you take these medicines temporarily and watch for improvement.
  1. N-Acetyl cysteine 600 mg tablet taken twice daily in empty stomach will help lighten the mucus and bring it out of the cavities.
  2. Anti-inflammatory medicines comprising Trypsin-Chymotrypsin-Bromelain-Rutoside help reduce edema and inflammation. They are also taken twice daily for a period of five to seven days.
  • I would say these two medicines would suffice for now. I am tempted to give you an anti-inflammatory nasal spray, but I would rather have a look inside using an endoscope before prescribing that.
  • There is no need for an antibiotic, as signs of bacterial infection seem to be less in your case. However, if you have started a course, it is prudent to complete the same.

Do revert back if you need any clarification. If you can upload a better picture of the throat with an open mouth, it will be really helpful. If an endoscopy is being performed, do let us know the findings. Eager to get you well.

For more information consult an ENT otolaryngologist online --> https://icliniq.com./ask-a-doctor-online/ENT-Otolaryngologist

Thank you doctor,

These are my CT scans of the brain and sinus. I went to a doctor to obtain nasal endoscopy. I will have that next week. These are my actual CT scans for brain and sinus. The doctor said that it could be GERD, and that staying away from acidic foods can help. What do you think? Also, I have orange oil in the toilet when I defecate. Could brain fog be related to any of these? Sometimes, I cannot do even basic math, and I am a math tutor. I do not do drugs or drink alcohol or smoke. Please help.

Dr. Shyam Kalyan N

MBBS (MADRAS MEDICAL COLLEGE)., DLO., CERTIFICATE IN ALLERGIC RHINITIS MANAGEMENT., DNB
Allergy Specialist Otolaryngology (E.N.T)

Hello,

Welcome to icliniq.com.

  • I looked through the CT images and they are normal. There are no signs of sinonasal inflammation. Enlarged middle turbinates are present which can potentially block sinonasal drainage but right now the symptoms are not due to that.
  • How is the response with the medicines I suggested? Did you take those for a week? How do you feel now? Is the mucus still there along with other symptoms that you described to me?
  • Gastroesophageal reflux disease (GERD) which manifests in the throat as laryngopharyngeal reflux is a very common disorder with symptoms similar to yours. It produces an increased throat mucus. The throat mucus causes a change in the voice, feeling of throat pain, headache, ear block, etc.
  • I would also suggest that you take medicines for GERD for about two weeks and review. In addition to medicines, you must follow some precautions. In this case, they are as follows.
  1. Eat food timely.
  2. Do not fast.
  3. Eat non-spicy, non-oily, non-fried foods.
  4. Avoid coffee, tea, smoke, alcohol, soda and carbonated drinks.
  5. Avoid caffeine and products that have caffeine.
  6. Exercise an hour each day.
  7. Do not lie down immediately after food.
  8. Do not drink a lot of water soon after meals.
  • Medicines for GERD are based on reducing the acid production in the stomach. They include Pantoprazole 40 mg, Lansoprazole, Omeprazole, and Rabeprazole. Any of these medications can be taken daily twice before meals.
  • I would suggest taking an antacid syrup that will neutralize the acid that is already produced. Mucaine gel (Aluminium hydroxide and Milk of Magnesia), 2 teaspoons taken after each meal and before bedtime accomplishes the purpose. The medicines I told you previously also have a role in GERD. They help bring out mucus and reduce inflammation.
  • I would suggest you take the GERD medicines for two to three weeks regularly and the medicines listed in the previous reply for another week and let us know the progress.

For further queries consult an ENT otolaryngologist online --> https://icliniq.com./ask-a-doctor-online/ENT-Otolaryngologist

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