Nasal Congestion and Blood-Streaked Mucus: When to Seek Further Evaluation

One side of the nose is more congested, and there is sometimes a slight presence of blood in the nasal discharge?

Hello Doctor: Two weeks ago, I experienced slight nasal obstruction on the right side, and sometimes there were traces of blood in my nasal discharge.
I also have intermittent pain in the muscles of my head and neck.
However, after visiting an ENT specialist and undergoing an endoscopic examination, the doctor stated that there were no concerning findings in my nasal cavity and simply attributed it to allergic nasal congestion, prescribing me allergy medications and a nasal spray.
As of today (two weeks later), I still feel slight obstruction in my nose (it feels like something is blocking it), and occasionally there is blood in my nasal discharge.
The muscle pain in my head and neck persists intermittently, and sometimes I even experience a tingling sensation in my face.
Could this be nasopharyngeal cancer? After reviewing the six major characteristics of nasopharyngeal cancer, I am quite worried.
Should I request a follow-up examination or further testing from my doctor? If it is not nasopharyngeal cancer, what other conditions could be causing my symptoms?

An An, 10~19 year old female. Ask Date: 2020/05/04

Dr. Zheng Jueyi reply Otolaryngology

Hello, if an endoscopic examination of the nasopharynx shows no obvious tumors, nasopharyngeal carcinoma can be initially ruled out.
However, if symptoms persist, you should return for a follow-up visit to check for other potential issues such as bleeding points in the nasal cavity or a deviated septum.
Wishing you safety and good health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2020/05/04

More Info

It sounds like you are experiencing a concerning combination of symptoms, including nasal congestion, blood-streaked mucus, and intermittent head and neck pain. Given that you have already undergone an endoscopic examination and were told that there were no significant abnormalities, it is understandable that you might feel anxious about your condition, especially with the possibility of serious issues like nasopharyngeal cancer (NPC) lingering in your mind.

Firstly, it is important to note that while blood-streaked mucus can be alarming, it is not always indicative of a serious condition. Common causes of blood in nasal mucus include nasal trauma (such as from vigorous nose blowing), dry air, allergies, or even sinusitis. In your case, since you have been experiencing nasal congestion and have been prescribed allergy medications, it is possible that your symptoms are related to allergic rhinitis or sinusitis rather than a malignancy.

Regarding your concern about nasopharyngeal cancer, it is essential to consider the typical symptoms associated with this condition. Common signs of NPC include persistent nasal obstruction, frequent nosebleeds, hearing loss, and neck lumps due to lymph node involvement. While you mentioned experiencing some of these symptoms, the absence of significant findings during your endoscopic examination is reassuring. However, if you are still experiencing symptoms after two weeks of treatment, it is reasonable to seek further evaluation.

You can certainly request a follow-up appointment with your ENT specialist to discuss your ongoing symptoms. It may be beneficial to ask for additional imaging studies, such as a CT scan of the sinuses or nasopharynx, which can provide a more comprehensive view of the area and help identify any underlying issues that may not have been visible during the endoscopy. Additionally, if your symptoms persist or worsen, your doctor may consider performing a biopsy or further diagnostic tests to rule out any serious conditions.

In summary, while your symptoms are concerning, they do not automatically indicate nasopharyngeal cancer, especially given the normal findings from your previous examination. However, it is crucial to advocate for your health and seek further evaluation if your symptoms do not improve. Remember that early detection and treatment of any condition, whether benign or malignant, are key to achieving the best possible outcomes. Stay proactive about your health, and do not hesitate to communicate your concerns with your healthcare provider.

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