Nasal Drip with Blood: When to Seek ENT Care

Post-nasal drip with blood-tinged mucus?

Hello Dr.
Zheng: In mid-February, I experienced headaches, fatigue, nasal congestion, and a runny nose.
I visited the clinic three times without improvement, and finally, I couldn't stand it anymore and went to the emergency room where I was tested for influenza and had an X-ray.
The doctor mentioned that my lungs were slightly inflamed.
After about a week of treatment, the lung inflammation improved, but my nasal issues have not resolved.
The nasal congestion and post-nasal drip are severe (I need to use a nasal spray to sleep), and I can go through an entire pack of tissues in one night.
Since the beginning of my symptoms until now, the mucus has been clear, very thick, and bubbly, with the nasal crusts being white and also very thick.
The attending physician at the hospital told me that this would not improve quickly and prescribed some medications for nasal allergies and rhinitis.
However, after finishing the medication, my symptoms did not improve.
I then consulted another ENT specialist, and after taking their medication, my nasal congestion improved, and I no longer have a constant runny nose, but I still experience post-nasal drip.
My throat feels like it has phlegm stuck in the middle, and I need to drink a lot of warm water to temporarily relieve it.
The doctor mentioned that I have a slight deviation of the nasal septum on the left side.
Sometimes I feel tingling in my face, and I experience pain around my nose and eye sockets, as well as pain in the back of my head and neck.
My left ear feels stuffy, and I have little appetite and diminished taste sensation.
In the past few days, I haven't been blowing my nose; it just feels like the mucus is too thick to come out and is running down my throat.
I thought about using tissue to clean my nostrils gently, but when I pulled the tissue out, I noticed some blood spots.
Later, when I tried to cough out the mucus from my mouth, I found that it had dark red streaks in it.
Could this be nasopharyngeal cancer? Do I need to undergo any specific tests? Do general clinics offer tests for nasopharyngeal cancer?

Niming, 20~29 year old female. Ask Date: 2020/03/18

Dr. Zheng Jueyi reply Otolaryngology

Hello, if you are concerned, you can visit a hospital or clinic's otolaryngology department to have your nasopharynx examined.
Generally, this can be done using a mirror or a nasopharyngoscope.
Wishing you safety and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Otolaryngology Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2020/03/18

More Info

When experiencing nasal drip with blood, it is essential to understand the potential causes and when to seek care from an Ear, Nose, and Throat (ENT) specialist. Based on your description, it seems you have been dealing with persistent nasal congestion, thick nasal discharge, and now the presence of blood in your mucus. These symptoms can be concerning, especially when they persist despite treatment.

Firstly, the presence of blood in nasal mucus can often be attributed to several benign causes, such as nasal mucosal irritation, dryness, or trauma from frequent nose blowing or cleaning. Given that you have been experiencing significant nasal congestion and thick mucus, it is possible that the mucosa in your nasal passages has become irritated or even slightly damaged, leading to minor bleeding. This is particularly common in dry environments or during cold weather, where the nasal passages can dry out and become more susceptible to bleeding.

However, the combination of your symptoms—persistent nasal congestion, thick and sticky mucus, facial pain, and now blood in your mucus—warrants further investigation. The fact that you have experienced facial numbness and ear fullness could indicate that there is more going on than just simple nasal irritation. Conditions such as chronic sinusitis, nasal polyps, or even structural issues like a deviated septum can contribute to these symptoms and may require medical intervention.

Regarding your concern about nasal cancer (nasopharyngeal carcinoma), while it is a possibility, it is relatively rare, especially in younger individuals. However, certain risk factors, such as a history of Epstein-Barr virus infection, smoking, or exposure to specific environmental factors, can increase the likelihood. If you have persistent symptoms that do not improve with standard treatments, or if you notice other concerning signs such as unexplained weight loss, persistent sore throat, or difficulty swallowing, it is crucial to seek medical attention.

In terms of diagnostic procedures, an ENT specialist can perform a thorough examination, which may include a nasal endoscopy to visualize the nasal passages and nasopharynx directly. This procedure allows the doctor to assess for any abnormalities, such as tumors, polyps, or significant inflammation. Imaging studies, like a CT scan, may also be recommended to evaluate the sinuses and surrounding structures more comprehensively.

As for your question about whether general clinics can perform tests for nasopharyngeal cancer, it is typically best to consult an ENT specialist for such evaluations. They have the necessary tools and expertise to conduct a thorough assessment and recommend appropriate tests.

In summary, while the presence of blood in your nasal mucus may not immediately indicate a severe condition, the persistence of your symptoms and the combination of other concerning signs suggest that it is prudent to seek further evaluation from an ENT specialist. They can provide a comprehensive assessment, rule out serious conditions, and develop an effective treatment plan tailored to your needs. Remember, early intervention can lead to better outcomes, so do not hesitate to seek care.

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