Nasal Issues: Chronic Inflammation and Possible Causes

Nasopharyngeal issues?

Hello, Dr.
Cheng! Last September, I experienced nasal congestion and a sore throat, which became severe after dragging on for a week or two before seeking medical attention.
Since then, I have started to experience post-nasal drip, especially when brushing my teeth, where I feel irritation in my nasal cavity and sometimes expel foam along with mucus.
Occasionally, I wake up with yellow mucus.
I'm unsure why this started after just one cold.

Then in November, I suddenly felt a foreign body sensation in my nose, and when I suctioned, I noticed dark red blood clots.
In January and February of this year, I had two similar episodes, and by March, it became quite frequent, with yellow mucus containing dark red blood clots.
Upon looking in the mirror, I noticed that the inferior turbinate on one side was very red and swollen, completely obstructing my nasal passage.
I took antibiotics for over a month, but the blood clots persisted.
After stopping the medication for two weeks, a nasopharyngeal biopsy revealed chronic inflammation.
Two weeks later, I underwent a CT scan without contrast, which showed no signs of chronic sinusitis.

What confuses me is that I have had unilateral post-nasal drip with blood clots for over six months, and the frequency only decreased after stopping the medication.
After more than a month, it has recently resolved on its own.
Dr.
Cheng, could you please explain why this phenomenon occurred? Is it possible that a tumor is growing beneath the mucosa, causing chronic nasopharyngitis? Could the absence of contrast have resulted in the tumor not being visible? Additionally, could occasional nail polish application cause nasal inflammation leading to bleeding? I have never experienced any of these symptoms before.
Is this a change in my constitution, or could there be other potential causes?

Zhang Yanting, 30~39 year old female. Ask Date: 2020/07/03

Dr. Zheng Jueyi reply Otolaryngology

Hello, if the nasopharyngeal biopsy shows chronic inflammation and the CT scan does not indicate chronic sinusitis, and the current symptoms have improved, it is advisable to self-monitor and return for regular follow-up appointments.
Concerns about tumors can be temporarily ruled out since both endoscopy and imaging have been performed.
As for the unilateral nasal discharge with blood clots lasting over six months, we can only speculate whether it is related to sinusitis, as it has improved after antibiotic treatment.
Wishing you peace and good health.
Sincerely, Dr.
Jue-Yi Cheng, Head of the ENT Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2020/07/03

More Info

Nasal congestion can be a frustrating and debilitating issue, especially when it interferes with sleep and daily activities. Based on the symptoms you've described, it seems you may be dealing with a combination of factors that could be contributing to your nasal congestion and related symptoms.
Firstly, it's important to understand that nasal congestion can arise from various causes, including infections, structural abnormalities, allergic reactions, and even environmental factors. In your case, the history of a severe cold followed by persistent nasal symptoms suggests that you may have developed post-viral rhinitis or chronic rhinosinusitis. This condition can occur after a viral infection, where the nasal passages remain inflamed and congested even after the initial infection has resolved.

The presence of yellow nasal discharge and blood-tinged mucus indicates that there may be ongoing inflammation or irritation in your nasal passages. This could be due to several reasons:
1. Chronic Inflammation: Chronic rhinosinusitis can lead to persistent inflammation of the nasal mucosa, resulting in symptoms like nasal congestion, post-nasal drip, and even nasal bleeding. The inflammation can cause the blood vessels in the nasal lining to become fragile, leading to bleeding, especially when you blow your nose or when the nasal passages are dry.

2. Allergic Rhinitis: If you have developed allergies, this could also contribute to your symptoms. Allergic rhinitis can cause nasal congestion, sneezing, and post-nasal drip, which may exacerbate your condition. Environmental factors, such as exposure to dust, pollen, or even chemicals in nail polish, can trigger allergic reactions.

3. Structural Issues: You mentioned noticing a red and swollen inferior turbinate (nasal concha) on one side. This could indicate turbinate hypertrophy, which is an enlargement of the nasal turbinates that can obstruct airflow and contribute to congestion. Structural abnormalities, such as a deviated septum, can also lead to chronic nasal congestion.

4. Possible Tumors: While it's understandable to be concerned about the possibility of a tumor, it's important to note that nasal tumors are relatively rare. However, if you have persistent symptoms that do not respond to treatment, further evaluation by an ENT specialist is warranted. Imaging studies, such as a CT scan with contrast, can help identify any masses or structural abnormalities that may not have been visible in previous scans.

5. Environmental Irritants: The use of nail polish and other chemicals can irritate the nasal mucosa, leading to inflammation and increased mucus production. If you notice that certain products trigger your symptoms, it may be beneficial to avoid them.

Given the complexity of your symptoms, it is crucial to consult with an ENT specialist who can perform a thorough examination, including nasal endoscopy if necessary, to assess the condition of your nasal passages and identify any underlying issues. Treatment options may include nasal corticosteroids to reduce inflammation, saline nasal rinses to clear mucus, and possibly allergy testing if allergic rhinitis is suspected.

In summary, your symptoms may be due to a combination of chronic inflammation, possible allergic reactions, and structural issues in your nasal passages. It's essential to seek professional medical advice to determine the exact cause and receive appropriate treatment to alleviate your symptoms and improve your quality of life.

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