Nosebleeds and Ear Congestion: Causes and Concerns

Nosebleeds and a sensation of ear fullness?

Hello Dr.
Zheng,
In March, I started noticing blood in the mucus from my right nostril.
Initially, I thought it was due to picking my nose too hard, but later I discovered blood streaks in my postnasal drip as well.
The amount of blood is not significant, but it occurs daily.
After two weeks, I visited an ENT specialist who performed an endoscopy and found no abnormalities in my nasal cavity, only that there was more mucus on the right side.
A month later, the condition persisted, so I went to another clinic.
The doctor also found no major issues after another endoscopy, only noting that the inner side of my nose appeared slightly red, suggesting a possible bleeding point.
Around this time, I began to experience occasional feelings of fullness in my ears.
The doctor examined me and believed it was unrelated to my nasal issues, possibly due to inflammation from earwax removal.
Initially, there was no pain in my nose when the bleeding started, but over the past month, I have begun to feel pain near the lower turbinate area, which sometimes radiates to my forehead and temples.
I also feel slight swelling under my eyes, and the ear fullness and pain contribute to discomfort in my head and the back of my skull.
I would like to ask the following questions:
1.
If there is a tear inside my nose, can it take this long to heal without any further irritation?
2.
Is the fullness in my ears related to the nasal bleeding?
3.
I have undergone rhinoplasty; could this be a cause of a possible implant infection?
It has been about half a month since my last consultation, and the symptoms of blood-streaked mucus and ear fullness continue.
I am considering whether to go to a larger hospital for further examination, but I am concerned that the doctor may perform another endoscopy and find no abnormalities, continuing to prescribe pain relief and anti-inflammatory medications.
Thank you for your response.

Violet, 20~29 year old female. Ask Date: 2020/06/22

Dr. Zheng Jueyi reply Otolaryngology

Hello,
1.
Generally, superficial skin wounds heal and improve within 1 to 2 weeks.

2.
The sensation of fullness in the ear is often related to Eustachian tube function.
If there are no abnormalities found during a nasopharyngoscopy, it may not necessarily be related to nasal bleeding.

3.
The absence of significant redness, swelling, heat, or pain may indicate that there is less likelihood of a prosthetic infection.
If symptoms persist without improvement, it is advisable to visit the ENT department at the hospital for further evaluation.
Wishing you safety and health,
Director of ENT Department, Taoyuan Hospital, Ministry of Health and Welfare
Dr.
Jue-Yi Cheng

Reply Date: 2020/06/22

More Info

Understanding the symptoms you are experiencing, including nosebleeds, ear congestion, and associated pain, is crucial for determining the underlying causes and appropriate management. Based on your description, there are several potential factors to consider.

1. Nasal Mucosal Injury and Healing: If there is a small tear or injury in the nasal mucosa, it can take time to heal, especially if there is continued irritation from actions such as nose-picking or exposure to dry air. The nasal mucosa is highly vascular, meaning it has a rich blood supply, which can lead to bleeding when irritated. If you have been experiencing blood in your nasal mucus for an extended period, it is essential to avoid further irritation and consider using a saline nasal spray to keep the mucosa moist. If the injury persists without healing, it may be worth consulting an ENT specialist for further evaluation, as chronic irritation can lead to more significant issues.

2. Connection Between Nasal Symptoms and Ear Congestion: The ear and nose are interconnected through the Eustachian tube, which helps equalize pressure in the middle ear. If there is inflammation or congestion in the nasal passages, it can lead to Eustachian tube dysfunction, resulting in a feeling of fullness or pressure in the ears. This can also cause discomfort and may contribute to ear pain. Given your symptoms of ear congestion alongside nasal bleeding, it is plausible that they are related. Addressing the nasal issues may help alleviate the ear symptoms.

3. Post-Surgical Considerations: If you have undergone rhinoplasty, it is essential to consider the possibility of complications such as infection or scarring. While it is less common, infections can occur post-surgery, leading to symptoms such as persistent pain, swelling, or unusual discharge. If you suspect that your symptoms may be related to the surgical site, it is crucial to discuss this with your healthcare provider. They may recommend imaging studies or further examinations to rule out complications.

4. Further Evaluation: Given that your symptoms have persisted for an extended period, it may be beneficial to seek a second opinion or further evaluation from a specialized ENT clinic or a tertiary care center. While previous examinations have not revealed significant abnormalities, persistent symptoms warrant a thorough investigation. This may include imaging studies such as a CT scan of the sinuses to assess for any underlying issues that may not be visible through endoscopy.

5. Management Strategies: In the meantime, consider implementing some self-care measures. Staying hydrated, using a humidifier, and avoiding irritants such as smoke or strong odors can help reduce nasal irritation. Over-the-counter saline nasal sprays can also be beneficial in keeping the nasal passages moist. If you experience significant pain or discomfort, discussing pain management options with your healthcare provider is advisable.

In conclusion, while your symptoms may seem interconnected, a comprehensive evaluation is necessary to determine the underlying causes accurately. Persistent nasal bleeding and ear congestion can indicate various conditions, and addressing them promptly is essential, especially considering your history of nasal surgery. Don't hesitate to seek further medical advice to ensure your concerns are thoroughly investigated and managed appropriately.

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