I would like to know what can be done about chronic halitosis. My dentist can find no reason for it,and advised me to see a doctor.My doctor found no cause,and referred me to an ear,nose and throat specialist. He found nothing definite,but did suggest surgery to open my breathing pasages,which was done.
Other seemingly related symptoms are a coated tongue and sometimes an irritable-bowel syndrome.I have eliminated most caffeine to help that problem.
This is my only serious health problem,and its an embarrassing an frustrating one.
Is there some way to find the cause?
Answer -----------
Chronic halitosis (offensive or foul breath) has multiple causes. While the symptom may seem more of a nuisance and an embarrassment it can occasionally be a sign of serious, even systemic illness.
Halitosis may be normal or physiologic. This would be typically seen in so called "morning breath" which results from enzymatic breakdown of cellular proteins and amino acids. Other physiologic origins of halitosis include hunger, dehydration, or it may be related to the ingestion of certain foods.
Oral conditions associated with halitosis can usually be determined by careful oral examination. Common conditions include dental caries (cavities), other dental or gingival conditions, or simply poor dental hygiene.
Nasal or throat conditions may cause halitosis. Common conditions include sinusitis; chronic nasal airway obstruction (such as which might occur with a deviated nasal septum) with secondary drying effect in the throat lining; chronic tonsillitis particularly when associated with deep crevices known as crypts which accumulate partially digested food; other inflammatory conditions associated with injury to the mucosal lining (ex canker sores); or tumors of the mucosal lining. These conditions generally are also readily evident on physical examination.
Halitosis may be related to odors which are excreted in expired air from the lungs. The foul breath associated with intake of garlic is actually a result of excretion via expired air from the lungs. Certain medications also release odors into expired breath from the lungs. All of these ingested substances are metabolized usually in the liver with breakdown products travelling in the blood stream where they eventually reach the lung tissues where a gas exchange occurs.
Reflux of stomach acids into the esophagus and as high as the throat is known as gastroesophageal refux and can be associated with a variety of vague throat symptoms including halitosis. Other common symptoms of this condition include the sensation of a "lump in the throat", thick phlegm or drainage in the throat, frequent throat clearing, and occasionaly hoarseness. Additionally these symptoms may occur in the absence of "heartburn". Simple measures can often relieve this problem such as keeping your head somewhat elevated at night (ie 2-3 pillows) to prevent the effects of gravitational flow of acid from reaching the throat, judicious use of antacids, avoidance of large meals shortly before bedtime. Occasionally gastroesophageal reflux requires prescription medication if symptoms are severe (eg Zantac, Prilosec, Propulsid, etc.) There are some signs visible on physical examination of the throat and larynx that are typically seen with reflux. Occasionally it is necessary to do more in depth study to make the diagnosis including barium esophagram, pH monitoring, or endoscopy.
Occasionally halitosis is a sign of systemic illness. Examples of this include uremia (kidney failure), a complication of diabetes known as diabetic ketoacidosis, or liver failure. These conditions would generally be associated with other more serious symptoms.
Unfortunately there is no simple efficient test to determine the cause of halitosis that is better than a history and physical examination. In the absence of nasal, oral, dental, or throat findings on physical examination, and when there are no associated dietary or medication factors known, I would consider the possibility of gastroesophageal reflux.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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