Blood-tinged Postnasal Drip: Causes and Concerns

Nasal mucus with blood has been present for three months?

Hello Doctor, I started experiencing symptoms of post-nasal drip with blood at the end of July this year.
Initially, there were only slight streaks of bright red blood, and it wasn't present every time.
It disappeared for about half a month, but in the following months, I continued to seek medical attention.
I underwent rigid endoscopy, and in my most recent visit, I even had a flexible endoscopy at a large hospital.
The conclusion from several doctors was that no tumors were found, which allows for the preliminary exclusion of my concern about nasopharyngeal cancer.
Instead, it seems that my history of allergic rhinitis and a deviated septum may be causing the nasal mucosa to bleed and mix with the post-nasal drip.
Previously, I would only notice blood streaks when I had a cold, but recently, I've observed that within two hours of waking up in the morning, the post-nasal drip has shown a significant amount of blood streaks.
At other times, there are occasional blood streaks, and the post-nasal drip sometimes appears light yellow or colorless.
There is no family history of head and neck cancer, and I have not found any lumps in my neck or experienced ear fullness.
I would like to seek your clarification, thank you!

Jim, 20~29 year old female. Ask Date: 2021/10/24

Dr. Ji Zhaoyun reply Otolaryngology

Hello, based on your description, 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 cavity tumors (like 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 examination.
If oral medication is not effective, consideration can be given to using medication or laser treatment to cauterize the frequently bleeding nasal blood vessels.
Wishing you peace and good health.

Reply Date: 2021/10/24

More Info

Blood-tinged postnasal drip can be a concerning symptom, especially when it appears suddenly or persists over time. Based on your description, it seems that you have been experiencing intermittent blood-tinged nasal discharge since late July, with a history of allergic rhinitis and a deviated septum. It's good to hear that multiple doctors have ruled out more serious conditions like nasopharyngeal cancer through various examinations, including flexible endoscopy.

The presence of blood in your postnasal drip can be attributed to several factors, particularly in the context of your existing conditions. Allergic rhinitis can lead to inflammation and irritation of the nasal mucosa, making it more susceptible to bleeding. The deviated septum may also contribute to uneven airflow and pressure in the nasal passages, which can exacerbate irritation and lead to localized bleeding.

Here are some potential causes and considerations regarding your symptoms:
1. Nasal Mucosal Irritation: Chronic inflammation from allergic rhinitis can cause the nasal mucosa to become fragile. This fragility can result in minor bleeding, especially during episodes of sneezing or blowing your nose.

2. Dry Air: If you live in a dry climate or are exposed to dry indoor air (especially during winter months), this can dry out the nasal passages and lead to bleeding. Using a humidifier can help alleviate this issue.

3. Infection: While you mentioned that the blood-tinged discharge has been present without significant infection, it’s worth noting that sinus infections or upper respiratory infections can also lead to blood-tinged mucus. If you experience other symptoms like fever, facial pain, or a persistent cough, it may warrant further investigation.

4. Nasal Polyps: Although your recent examinations did not reveal tumors, nasal polyps can also cause similar symptoms. These benign growths can develop in the nasal passages and sinuses, leading to obstruction and irritation.

5. Vascular Issues: In some cases, the presence of blood can be linked to vascular abnormalities in the nasal cavity. Conditions such as hereditary hemorrhagic telangiectasia (HHT) can cause recurrent nosebleeds and should be considered if symptoms persist.

6. Medication Side Effects: If you are taking any medications, particularly anticoagulants or anti-inflammatory drugs, these could contribute to increased bleeding tendencies.

Given your symptoms, here are some recommendations for management and monitoring:
- Nasal Saline Irrigation: Using saline nasal sprays or performing nasal irrigation can help keep the nasal passages moist and reduce irritation.

- Avoid Irritants: Try to avoid known allergens and irritants, such as smoke, strong odors, and pollutants, which can exacerbate your symptoms.

- Monitor Symptoms: Keep a diary of your symptoms, noting when the blood-tinged mucus occurs, its frequency, and any associated symptoms. This can help your healthcare provider identify patterns and potential triggers.

- Follow-Up Care: Since you have already consulted with multiple specialists, it may be beneficial to have regular follow-ups to monitor your condition. If symptoms worsen or new symptoms arise, such as significant pain, swelling, or changes in vision or hearing, seek immediate medical attention.

In summary, while the presence of blood-tinged postnasal drip can be alarming, it is often related to benign causes, especially in the context of allergic rhinitis and structural nasal issues. Continued monitoring and appropriate management can help alleviate your symptoms and improve your quality of life. If you have further concerns or if your symptoms change, do not hesitate to reach out to your healthcare provider for additional evaluation and guidance.

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