Blood-Streaked Phlegm and Throat Discomfort: ENT Insights

Sore throat with blood-tinged sputum?

Hello Doctor, I have had tonsil stones for the past two years, but they were small and not frequent, usually coming out on their own when I cough.
Recently, for the past two weeks, I have been feeling discomfort on the right side of my tonsil, and I noticed a foul smell when I breathe.
I have been clearing my throat, trying to cough it out.
Last Tuesday, I tried to induce vomiting to see if I could expel it, but I only brought up phlegm, which had streaks of blood in it.
Even yesterday, I kept clearing my throat because I felt a persistent blockage on the right side, and the phlegm still had blood streaks.
My throat feels extremely dry, and even drinking water doesn't help; it feels dry.
The presence of blood in the phlegm has been concerning for almost a week.
I went to the ENT department at the hospital, and the doctor examined my throat, noting a small ulcer on the right side that might be causing the blood-streaked phlegm.
They performed a nasal endoscopy and said everything in the nasopharynx looked fine, but my tonsils were somewhat enlarged, and there was a lot of phlegm in my throat.
The tonsils were otherwise normal, and I was advised to drink more water and to avoid clearing my throat.
However, I was still worried, so I visited a clinic in the afternoon.
They used different equipment than the hospital to examine my nose and showed me the images, confirming that my nasal cavity only had some mucus, which was normal.
They also checked my tonsils and said they were completely clear of stones and that my throat was fine, with no ulcers.
It was suggested that the blood might be due to small ruptured blood vessels in my throat and that I should avoid clearing my throat.
They also mentioned that I might have gastroesophageal reflux disease (GERD).

My question for you, Doctor, is that when I woke up today, I had phlegm in my throat, and when I coughed it up in the morning, there were again a few streaks of blood, and I haven't been clearing my throat.
If my nose and throat are fine, how long will it take for the blood streaks in the phlegm to resolve? Also, do I need to undergo any further tests? Is it okay that I had two invasive nasal endoscopies yesterday? Two years ago, I went to National Taiwan University Hospital and the Zhongxiao ENT clinic for nasal endoscopy because of the same right-sided tonsil discomfort, and they said everything was normal, suggesting it might be GERD.
I had an endoscopy done, which was normal, and the doctors confirmed there was no GERD.
Later, a clinic doctor said it was tonsil stones and helped me clear them, but it was very painful, and I was hesitant to return to that clinic.
Generally, I can't see any stones when I check my tonsils myself, and sometimes I cough up very small stones in the morning, occasionally slightly larger than a grain of salt.
I would also like to ask, is the persistent feeling of blockage on the right side related to the stones?

Wenwen, 30~39 year old female. Ask Date: 2017/09/20

Dr. Zheng Jueyi reply Otolaryngology

Hello, generally, a wound should fully improve within about a week.
As for the discomfort, it may be related to chronic tonsillitis or stones.
It is recommended to drink plenty of water, gargle, and maintain a regular routine.
Thank you for your message.
Wishing you peace and good health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2017/09/20

More Info

When it comes to understanding blood-streaked phlegm and throat discomfort, especially in the context of your history with tonsil stones and recent symptoms, it's essential to approach the situation with a comprehensive understanding of potential causes and appropriate medical advice.

From your description, it seems you have been experiencing discomfort in your right tonsil area, along with a sensation of something being stuck, foul breath, and the presence of blood-streaked phlegm. You have also undergone examinations by ENT specialists who have ruled out significant issues such as tonsil stones and nasal problems, suggesting instead that the blood in your phlegm may be due to minor ruptures in small blood vessels in your throat, possibly exacerbated by frequent throat clearing.

Understanding Blood-Streaked Phlegm
Blood-streaked phlegm can arise from various causes, including:
1. Minor Trauma: Frequent throat clearing or coughing can irritate the throat and lead to small blood vessel ruptures, resulting in blood-streaked phlegm. This is often benign and self-limiting.

2. Infections: Viral or bacterial infections can cause inflammation in the throat, leading to increased mucus production and potential bleeding. However, given that your ENT evaluations have not indicated an active infection, this seems less likely in your case.

3. Gastroesophageal Reflux Disease (GERD): As suggested by one of your doctors, GERD can lead to irritation of the throat and esophagus, which may cause discomfort and contribute to the sensation of something being stuck in your throat. This condition can also lead to blood-streaked phlegm if the irritation is severe enough.

4. Allergies or Irritants: Allergens or irritants in the environment can cause throat irritation, leading to increased mucus production and potential bleeding.

Recommendations for Management
1. Hydration: Continue to drink plenty of fluids. Staying hydrated can help thin mucus and soothe throat irritation.

2. Avoid Throat Clearing: As advised by your doctors, try to minimize throat clearing. This can prevent further irritation and allow any minor injuries to heal.

3. Monitor Symptoms: Keep an eye on your symptoms. If the blood in your phlegm persists, increases, or is accompanied by other concerning symptoms (such as significant pain, difficulty breathing, or fever), seek medical attention promptly.

4. Follow-Up with ENT: If symptoms do not improve or if you have ongoing concerns, consider scheduling a follow-up appointment with an ENT specialist. They may recommend further evaluation or treatment options.

5. Consider GERD Management: If GERD is suspected, lifestyle modifications such as avoiding trigger foods, not eating close to bedtime, and elevating the head while sleeping may help. Discuss with your doctor whether a trial of acid-reducing medications is appropriate.

Regarding the Invasive Procedures
You mentioned undergoing two invasive nasal endoscopies. While these procedures can be uncomfortable, they are generally safe and provide valuable information about the condition of your nasal passages and throat. If you experienced any unusual symptoms following these procedures, such as increased bleeding or severe pain, it would be wise to consult your healthcare provider.

Conclusion
In summary, while the presence of blood-streaked phlegm can be alarming, it is often due to minor, self-limiting issues. Given your history and the evaluations you've undergone, it seems likely that your symptoms may resolve with conservative management. However, ongoing monitoring and communication with your healthcare providers are essential to ensure that any underlying issues are addressed appropriately. If you have further questions or concerns, do not hesitate to reach out to your healthcare team for personalized advice and support.

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