Chronic Nasal Swelling and Blood-Scented Mucus: Allergy or Cancer Risk?

Chronic nasal swelling with yellow nasal discharge that has a bloody odor?

Hello, Doctor.
I would like to ask a few questions.
Due to congenital allergies, I often experience symptoms such as sneezing.
However, I have noticed that the polyps in my nose have been persistently swollen for several years, almost year-round, regardless of the season.
Sometimes, I feel a slight stinging sensation.
Recently, I have frequently detected a strong metallic smell, and when I wipe with tissue, I can see yellow mucus, occasionally with small streaks of blood.

1.
I would like to know if this allergic rhinitis, which leads to chronic congestion and inflammation of the nasal polyps, increases the risk of developing nasopharyngeal cancer or other nasal cancers?
2.
Additionally, if the allergies or internal swelling become more severe, can the nasal mucosa even start to bleed?
3.
During allergy seasons, when the symptoms are unbearable and I am sneezing excessively, I use a cotton swab dipped in topical ointment to apply deeply inside my nasal cavity, reaching about two-thirds of the swab's length.
Although this process is quite stimulating, it also provides a scratching sensation, especially as I can distinctly feel many "protruding" growths in the upper right part of my nasal cavity.
Applying pressure with the cotton swab on these growths gives a sensation similar to scratching a mosquito bite, and after this intense stimulation, it significantly alleviates my severe allergy symptoms.
Could this lead to any long-term side effects?
4.
This issue has troubled me for most of my life.
I have previously sought help from traditional Chinese medicine, which required long-term medication, and Western medicine only prescribed acute anti-inflammatory drugs.
I would like to know if there are any curative methods available (besides surgical removal of the polyps).
Are folk remedies like the Sanfu plaster effective? I currently work night shifts.
Thank you, Doctor, for your patient answers.

[email protected], 30~39 year old female. Ask Date: 2019/04/28

Dr. Ji Zhaoyun reply Otolaryngology

Hello, based on your description regarding allergic rhinitis, here are several important concepts: The primary triggers are the individual's constitution and environmental allergens and irritants.
If one parent has allergic rhinitis, the likelihood of their children developing it is four times higher.
The most common allergen is dust mites, followed by animals, insects, mold, and pollen.
Recently recognized fine particulate matter (PM2.5) is also a significant irritant.

Treatment typically begins with oral medications and nasal sprays, and surgery may be considered if necessary.
The main medications include oral antihistamines and intranasal corticosteroid sprays, often combined with topical antihistamines/vasoconstrictors or oral leukotriene receptor antagonists as needed.
If symptoms do not improve with medication and there is significant structural obstruction, such as a deviated septum, turbinate hypertrophy, or nasal valve narrowing, appropriate surgical intervention may be beneficial.
Recently, minimally invasive surgical techniques have been developed, which require shorter operation times and do not necessitate hospitalization, making them widely applicable.
To avoid allergens and reduce irritants, wearing masks, maintaining a clean home environment, regularly washing bedding, avoiding extreme temperature/humidity changes, and reducing outdoor activities during severe PM2.5 air pollution are key points for daily care.
Although allergic rhinitis can be bothersome, with appropriate medication or combined surgery, and by avoiding allergens and irritants, it can be well-controlled, significantly improving quality of life and enhancing academic and work performance.
There are many causes of nosebleeds, the most common being thin nasal mucosa leading to bleeding from forceful nose blowing.
However, conditions such as nasopharyngeal or nasal tumors (e.g., nasopharyngeal carcinoma), sinusitis, fungal infections, allergic rhinitis, hypertension, coagulopathy, and nasal trauma can also lead to nosebleeds.
It is advisable to consult an otolaryngologist for evaluation.
If oral medication is ineffective, cauterization of the frequently bleeding nasal vessels using medication or laser treatment may be considered.
Common symptoms of sinusitis include nasal congestion, yellow-green nasal discharge, fever, facial pain, foul odor, and changes in smell, but not all symptoms may be present.
Diagnostic methods include endoscopy and imaging studies.
If acute sinusitis persists despite antibiotic treatment for more than two weeks, it is recommended to visit an otolaryngologist for bacterial culture.
If a more virulent bacteria is identified, a stronger antibiotic may be necessary.
You may consider purchasing a "nasal irrigation device" (containing isotonic saline) to perform daily rinses 1-2 times, which can enhance the treatment of sinusitis.
Additionally, avoid staying up late, refrain from smoking, and for those with diabetes, control blood sugar levels.
If sinusitis does not resolve after more than 2-3 months of treatment, it is highly likely to be "chronic" sinusitis, requiring further evaluation and possibly surgical intervention.
It is recommended to consult an otolaryngologist for assessment.
Wishing you peace and health.
This is purely an exchange of concepts; all should be based on the physician's actual consultation.

Director of the Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare, Chi Chao-Yun.

Reply Date: 2019/04/28

More Info

Chronic nasal swelling and the presence of blood-scented mucus can be concerning symptoms, especially for someone with a history of allergies and nasal polyps. Let's break down your questions and concerns regarding the potential risks of nasal cancer, the implications of your symptoms, and possible treatment options.

1. Risk of Nasopharyngeal Cancer: Chronic inflammation caused by allergic rhinitis and nasal polyps can lead to various complications, but the direct link between these conditions and nasopharyngeal cancer is not well established. While chronic irritation and inflammation in the nasal passages can theoretically contribute to changes in the mucosal lining, the majority of cases of nasopharyngeal cancer are associated with other risk factors, such as Epstein-Barr virus (EBV) infection, smoking, and certain dietary factors. Your symptoms, including the presence of blood-stained mucus, could be indicative of severe allergic reactions or infections rather than cancer. However, it is essential to monitor these symptoms closely and consult with an ENT specialist for further evaluation, especially if the symptoms persist or worsen.

2. Nasal Mucosa and Bleeding: It is common for individuals with chronic allergies and nasal polyps to experience nasal mucosa that is inflamed and prone to bleeding. The nasal lining can become fragile due to ongoing inflammation, leading to small blood vessels breaking and causing blood-stained mucus. This is typically not a sign of cancer but rather a consequence of chronic irritation. However, if you notice an increase in the frequency or volume of bleeding, it is advisable to seek medical attention.

3. Self-treatment with Cotton Swabs: While it may provide temporary relief from itching and discomfort, using cotton swabs to aggressively stimulate the nasal passages can lead to further irritation, potential injury to the nasal mucosa, and increased risk of infection. The sensation of relief you experience may be short-lived, and this practice could exacerbate your symptoms in the long run. It is crucial to avoid invasive self-treatment methods and instead consult with a healthcare professional for appropriate management strategies.

4. Long-term Management and Treatment Options: Chronic nasal issues can be challenging to manage, especially when they significantly impact your quality of life. While surgical options like polypectomy can provide relief, they are not always necessary. Other treatment modalities include:
- Intranasal corticosteroids: These can help reduce inflammation and shrink nasal polyps.

- Antihistamines: These can alleviate allergy symptoms.

- Saline nasal irrigation: This can help clear mucus and allergens from the nasal passages.

- Immunotherapy: For those with significant allergic reactions, allergy shots or sublingual tablets may provide long-term relief.

- Lifestyle modifications: Avoiding known allergens, maintaining good nasal hygiene, and using air purifiers can help manage symptoms.

As for traditional remedies like "三伏貼" (Sanfu Tie), while some individuals report benefits from alternative therapies, scientific evidence supporting their efficacy is limited. It is essential to approach such treatments with caution and discuss them with your healthcare provider.

In conclusion, while your symptoms warrant attention, the likelihood of them being indicative of nasopharyngeal cancer is low, especially in the absence of other risk factors. However, persistent symptoms should be evaluated by an ENT specialist, who may recommend imaging studies or a biopsy if deemed necessary. A comprehensive approach to managing your allergies and nasal polyps will likely yield the best results in improving your quality of life.

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