EpistemisUnilateral foul-smelling rhinorrhea
Specialty: Otolaryngology.
Why it occurs
- Retained and forgotten foreign body in the nasal cavity (common in pediatric patients or patients with cognitive impairment)
- Unilateral maxillary sinusitis of odontogenic origin secondary to periodontitis or failed dental implant
- Rhinolith (calcareous concretion formed around a foreign body nucleus)
- Malignant necrotic sinonasal tumor superinfected with anaerobic germs
- Unilateral choanal atresia in adolescents or young adults diagnosed late
Initial workup
Rigid nasofibrolaryngoscopy without prior decongestion (so as not to displace a possible foreign body), high-resolution CT of the paranasal sinuses with contrast if tumor or odontogenic pathology is suspected, directed microbiological culture of purulent nasal exudate, and biopsy of any suspicious tissue.
red flags
Severe refractory facial pain that worsens at night, obvious eyelid or orbital swelling, intense fronto-parietal headache, recurrent ipsilateral epistaxis of moderate to severe volume, loosening of maxillary teeth without apparent periodontal pathology, or progressive loss of vision.
Standard management
- Empirical antibiotic therapy directed at aerobic and anaerobic microorganisms such as amoxicillin-clavulanic acid — 875/125 mg every 8 hours orally) or clindamycin (300 mg every 8 hours orally if there is an allergy to penicillins
- Instrumental removal of the foreign body by an otorhinolaryngologist
- Nasal washes with warm saline solution to facilitate the cleaning of debris after removal of the causative agent.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 5
- Treatment options
- 3