To Your Good Health: Embarrassing Bad Breath May Not Be Bad at All

Dear Dr. Roach: Could the cause of chronic bad breath be due to having a tortuous esophagus? I’ve always had a horrible taste in my mouth 10 to 20 minutes after eating — sometimes worse than others, depending on what I’ve eaten. I was diagnosed with GERD 10 years ago. I tried eliminating certain foods, had my tonsils removed in my late 20s and have brought it up with doctors a few times, to no avail.

I have regular cleanings every three months with a dental hygienist, and I floss regularly, gargle and brush my teeth two or three times a day. I do not enjoy going to social events or participating in group activities. I am too embarrassed to discuss this with anyone, including my gastroenterologist, who discovered this type of esophagus during my endoscopy. A TV doctor said there are millions of people out there who can’t find a cure for their bad breath. Please help me! — S.H.

Answer: There are indeed millions of people with bad breath, and many of them are unaware of it. On the other hand, millions of people who think they have bad breath do not, when examined objectively by professionals. This is largely because it is very difficult to judge what our own breath smells like. This is common enough that it has a name: halitophobia.

Approximately 80 percent to 90 percent of bad breath comes from the oral cavity; the nasal passages, tonsils and sinuses are the causes in nearly all the others. Bad breath almost never arises from the esophagus or stomach, so I don’t think your tortuous (a term meaning that the esophagus is twisted somewhat and doesn’t go straight down) esophagus is the cause.

A bad taste in your mouth certainly can come from having GERD. Many people think that the bad taste means their breath smells bad when, in fact, it doesn’t. I think you need to have an evaluation by an expert. Some ENT doctors have particular expertise in this area.

Dear Dr. Roach: In 1978, I was diagnosed with a benign brain tumor. It was on the pituitary gland and pushing on the optic nerve. I had surgery, but only half was removed because of the optic nerve. The other half was shrunk with chemo and radiation. I am concerned about the long-term effects of radiation, because I had a stroke in 2012 and the doctors said this stroke might have been a link to long-term effects of radiation. But 36 years later? Can you confirm or deny that the long-term effects of radiation cause stroke? — B.R.

Answer: I can’t tell you whether your stroke was caused by the radiation you received; however, I can confirm that high-dose radiation (from radiation therapy for your tumor, not from a diagnostic CT scan) increases the overall risk of transient ischemic attack and stroke. A well-done study from Australia in 2011 showed that radiation treatment approximately doubles the risk of TIA and stroke.

This does not mean that the treatment you had in 1978 was inappropriate. Treatment of a brain tumor, even a noncancerous one, is critical, because there is very little room in your head for a tumor in that position. The medical treatment we have now for these kinds of tumors was not available in 1978.

What this means for people with a history of radiation treatment to the head is that they should do everything to reduce their risk of stroke, which means no smoking, careful control of blood pressure and cholesterol, careful diet including low sodium and low sugar, and discussion with a doctor about aspirin therapy.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.