HALITOSIS

Ask the Following Questions:

1. Is there a history of ingestion or use of a foul substance? Such a history may suggest that the cause is onions, garlic, alcohol, tobacco, paraldehyde, mercury, or other substances.
2. Are there abnormalities of examination of the mouth, nose, and throat? Abnormalities that may be found on examination of the mouth, nose, and throat include gingivitis, carious teeth, pyorrhea, stomatitis, sinusitis, pharyngitis, and tonsillitis.
3. Is there a chronic productive cough? The presence of a chronic productive cough should suggest bronchiectasis, lung abscess, gangrene of the lungs, tuberculosis, and other lung infections.
4. Is there esophageal regurgitation? The history of esophageal regurgitation should suggest reflux esophagitis, peptic ulcer, partial intestinal obstruction, and esophageal diverticula. If there are none of these findings, one should look for uremia or cirrhosis.

DIAGNOSTIC WORKUP

Routine tests include a CBC and sedimentation rate to rule out chronic inflammation; a chemistry panel to rule out uremia and cirrhosis; and sputum, nose, and throat cultures to rule out chronic infections of the sinuses, nose, throat, and lungs. Cultures of any suspicious area of inflammation in the mouth, nose, and throat should be done. X-rays of the teeth, sinuses, and chest should also be done. An upper GI series and esophagogram will help diagnose reflux esophagitis, peptic ulcer, partial intestinal obstruction, and esophageal diverticula.

A 24-hr sputum collection may help differentiate bronchiectasis and lung abscesses. A tuberculin test and sputum for AFB smear, culture, and possible guinea pig inoculation may identify tuberculosis.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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