foreign bodies in toddlers are usually associated with an odor identified by parents as bad breath Nose Nasal drainage can be clear and odorless or mucopurulent and odiferous Nasal drainage and bleeding can reflect local infections, foreign bodies, irritations of the nasal passage, and sinus drainage Ear Sterile inner ear fluid is odorless but gives off a rank smell when infected Acute otitis externa is usually associated with a mucoid drainage, whereas chronic otitis externa produces a purulent, discolored drainage with a foul odor, usually caused by P aeruginosa or Staphylococcus aureus Genitalia Vaginal secretions are combinations of vulvar secretions from sebaceous, sweat, Bartholin and Skene glands, transudate through the vaginal wall, exfoliated cells, cervical mucus, endometrial and oviductal fluids, plus vaginal microorganisms and menstrual blood These secretions are hormonally mediated and vary with the menstrual cycle Odors are exacerbated by the presence of retained foreign bodies, including tampons and diaphragms Bacterial vaginosis (nonspecific vaginitis, Gardnerella vaginitis, Corynebacterium vaginitis, Haemophilus vaginitis, nonspecific vaginosis, and anaerobic vaginosis) is caused by an increase in anaerobic bacteria and a decrease in lactobacilli (see Chapter 92 Gynecology Emergencies ) The anaerobic bacteria act synergistically with Gardnerella vaginalis to produce enzymes and aminopeptidases that degrade proteins, and decarboxylases that convert amino acids and other compounds to amines The amines produce the characteristic “fishy” odor, which is best detected by alkalinization using 10% potassium hydroxide placed directly on a vaginal swab and smelling immediately This odor also can be indicative of sexual abuse in children Vaginal infection with Trichomonas often is associated with a fishy odor, whereas Candida vaginitis is notably free of odor A male counterpart, balanoposthitis, is associated with a urethral discharge that produces a fishy odor when alkalinized because of the same process and organisms that occur in bacterial vaginosis Urethral Meatus