What causes the musty smell in my mouth, nose?

Q: I have recently noticed a terrible musty smell and taste at the back of my nose and mouth when I inhale. Also, my left nostril feels swollen and breathing through it is more difficult than it was before. However, my doctor can see nothing wrong. I don’t have any dental problems and my oral hygiene is very good. What do you think?

Dr Ellie replies: The nose, mouth and sinuses are very common places to get an infection. Due to the presence of bacteria, or other microbes in these parts, this can lead to an unpleasant smell.

It’s possible that an infection could be present within the nose, throat, tonsils or even within the sinuses. This can be treated with salt water rinses or it may need antibiotics. There are also nasal washes such as Sterimar or NeilMed, which are available at most large pharmacies. Tonsils stones could be a cause of a smell within the back of the mouth. Mucus, debris and food can get caught in the crevices of the tonsils and cause small hardened lumps, called stones, which can smell. Salt water gargling can help to dislodge them. Having one nostril more blocked that the other could indicate there is a nasal polyp there. These are very common small growths.

They don’t usually create a bad smell but can alter your sense of smell. Nasal polyps can be cleared up with steroid sprays.

If this feeling is not clearing, then it is important to get a further examination.

There is a particularly rare type of cancer called nasopharyngeal cancer that grows at the back of the nose and mouth, that can cause one-sided nose blockages and changes to smell.

Q: For the past five years I’ve had constant breast pain. When it started, the breast developed blisters, which cleared after a week. But since then the pain has been unending. I had ultrasound scans but they uncovered nothing abnormal. The pain radiates up to the shoulder and down the whole arm. What’s your advice?

Dr Ellie replies: If the pain started after a week of blisters, it is most likely a shinglesrelated issue. Shingles causes a rash that usually lasts for about a week, which then blisters. It is often associated with a unique electric shock or cigarette burn type of pain.

For some people, unfortunately this pain will continue once the rash has gone and this is called post-herpetic neuralgia.

This diagnosis would not be seen on an ultrasound scan or any investigations, but would be confirmed if a doctor had seen the blisters in the first instance and the pain sounded like post-herpetic neuralgia.

Often this pain is worse when the skin is touched or under pressure, so wearing a bra every day could aggravate the issue.

Any symptoms in the breast that persist should be investigated, but after five years of symptoms and investigations it is imperative to look for symptom relief even if there is not a clear answer. As neuralgia is a very specific type of pain it usually requires different treatment to normal pain. Since the area will be very sensitive to touch, a protective layer over the breast may be helpful.

I would recommend trying adhesive wound dressing pads, which you purchase at most pharmacies. You can also get local anaesthetic plasters, which would have to be prescribed. These deliver pain relief just to the specific area and are recommended for neuralgia.

Doctors also offer specialist medications for this nerve pain and you can ask your GP or practice pharmacist about trying one.

Not only could this offer a solution, it would also point to a clear diagnosis if it works.

Q: I recently had a blood test and was shocked when I was told I had an underactive thyroid. I’m 76, have always been healthy and live a very active life. I’ve been given a prescription for a drug called levothyroxine, but I’m hesitant to take it as I don’t feel like I need it. What should I do?

Dr Ellie replies: The thyroid gland produces a hormone called thyroxine, which can be topped up by levothyroxine tablets.

Thyroxine controls and influences many processes in the body, from the growth of hair to the heart rate. As a result, an underactive thyroid can cause a host of different symptoms ranging from weight gain and tiredness to memory problems and depression. Often it is caused by an autoimmune condition, where the immune system targets its own body.

An underactive thyroid can lead to high cholesterol levels, heart disease and even heart failure. These complications can occur in patients who have never experienced symptoms, which is why it is important to take levothyroxine regardless of how you feel right now.

The good news is that the drug also has very few side-effects, though some patients may experience sweating, chest pain and headaches if their dose is too high. I would advise telling your GP that you are apprehensive about taking the tablet, so that they can give you all the information you need to feel comfortable beginning treatment.

Easter eggs sugary? Who knew!

Did we learn anything during the pandemic about public health messaging?

It would appear not, after an NHS trust last week advised its patients not to ‘eat an Easter egg in one go’.

The statement, which was put on social media, stated that the seasonal sweet treat should be enjoyed ‘in moderation’ to protect against the risk of obesity and type 2 diabetes.

I can’t see the value of this at all – one festive treat is not going to make anyone overweight or trigger diabetes.

These NHS edicts come across as patronising, and it’s unlikely they make much difference to people’s habits. Moreover, if we constantly tell patients how to live their lives, it’s less likely they will listen when the message is important – for example, how to protect themselves against a deadly new virus.

It’s no surprise the NHS trust has since deleted the message.