Cacosmia

Specialty: Otolaryngology.

• Constant perception of bad odor of intrinsic origin
• rotten smell subjective
• foul olfactory hallucination

Why it occurs

• Chronic sinusitis with nasal polyposis complicated by superinfection with anaerobic bacteria
• Presence of a long-standing retained foreign body in the nasal cavity with tissue necrosis
• Chronic tonsillitis with massive accumulation of caseum in the tonsillar crypts
• Infection of odontogenic origin (orosinusal fistula after extraction or severe apical periodontitis that compromises the maxillary sinus)
• Malignant tumor of the nasal cavity or paranasal sinuses with central necrotic tissue

Initial workup

Rigid or flexible nasofibrolaryngoscopy of the nasal passages and tonsillar meatuses, CT of the paranasal sinuses in coronal and axial projections, and directed biopsy of any mucosa or tissue with a vegetative or suspicious appearance identified in the endoscopy.

Standard management

• Amoxicillin with clavulanic acid — 875/125 mg every 8 hours orally for 10-14 days if sinusitis of bacterial or odontogenic origin is suspected
• Abundant nasal washes with saline solutions enriched with xylitol or sodium bicarbonate to remove debris and scabs
• Nasal corticosteroid spray such as fluticasone propionate (2 sprays per nostril every 12 hours if there is an evident polypoid inflammatory component).