Mark A. Zacharek

The perception of an abnormal odor in the patient’s nose can suggest many different pathologies.

Pertinent History

Duration

Short periods are suggestive of acute infection or inflammation.

Longer periods are suggestive of an obstructing mass or chronic infectious process.

Associated complaints

Pain

Loose dentition

Numbness: Suggests tumor infiltration

— Superior alveolar nerve

— Infraorbital nerve

Nasal airway obstruction

Previous trauma

Previous nasal or sinus surgery

Physical Examination

Attention to the facial symmetry of the patient is important. Observed mass effect on the septum or nasal vestibule, particularly when unilateral, raises suspicion for a tumor or congenital or odontogenic process.

Unilateral serous effusion may suggest eustachian tube obstruction or nasopharyngeal mass.

Cranial nerve exam

Anterior rhinoscopy

Nasal endoscopic (flexible or rigid) examination

Computed tomographic (CT) scan with contrast

Magnetic resonance imaging (MRI) scan with contrast

Etiologies of Foul Smell in Nose