Persistent Nosebleeds: When to Seek ENT Help

A concerning issue?

Hello Doctor: I have been experiencing nosebleeds for the past six months (I did not have this medical history before).
It started after a prolonged cold in March of this year (that cold lasted a long time).
The symptoms were particularly noticeable for two months, and afterward, I only had mild nasal congestion occasionally.
In March, I also experienced nosebleeds, and I visited an ENT specialist who examined my nose directly and told me there was nothing abnormal.
Since then, I frequently have nosebleeds in the afternoon and evening (after dinner), which occur unexpectedly and feel like a runny nose during a cold (the blood appears quite dark, and when I wipe with tissue, it is bright red).
Occasionally, I feel like there is mucus, and when I blow my nose, fresh blood comes out, which is really frightening.
Could this be an issue with my immune system? (I have had skin allergy symptoms over the past two years, and treatment has not improved my condition.) Recently, I have noticed an unusual taste in my mouth (initially thinking it was due to the heat of summer), and a few days later, I realized it was fluid seeping from my nasal cavity (with a metallic taste), but I cannot see any blood.
What should I do? What kind of tests do I need to undergo to determine if this could be an issue with my immune system? (I have had skin allergy symptoms over the past two years, and treatment has not improved my condition.)

Meigui, 30~39 year old female. Ask Date: 2004/08/16

Dr. Cai Hongyan reply Otolaryngology

1.
A detailed X-ray examination of the head and nasal endoscopy should be performed to check for the possibility of other conditions.
It is recommended to have the examination done at a major hospital.

2.
It is unlikely to be...

Reply Date: 2004/08/16

More Info

Persistent nosebleeds, or epistaxis, can be concerning, especially when they occur frequently and without a clear cause. Given your symptoms, including a history of nosebleeds for the past six months following a prolonged cold, it’s essential to consider several factors that could contribute to your condition.

Firstly, it’s important to understand that nosebleeds can arise from various causes, including environmental factors, anatomical issues, or underlying health conditions. Common causes include dry air, nasal trauma, allergies, and infections. In your case, since the nosebleeds began after a significant respiratory illness, it’s possible that the nasal mucosa was damaged during the infection, leading to increased susceptibility to bleeding.

You mentioned that you have experienced nasal congestion and occasional blood in your nasal discharge, which could indicate ongoing inflammation or irritation in the nasal passages. The presence of a bad taste or odor in your mouth could suggest post-nasal drip or sinus involvement, which may require further evaluation.

Given your symptoms and their persistence, it is advisable to seek further evaluation from an Ear, Nose, and Throat (ENT) specialist. Here are some steps you might consider:
1. Comprehensive ENT Evaluation: Since you have already seen an ENT specialist, it may be beneficial to return for a more thorough examination. This could include a nasal endoscopy, where a small camera is inserted into the nasal passages to visualize the interior structures more clearly. This procedure can help identify any abnormalities, such as polyps, tumors, or chronic sinusitis.

2. Allergy Testing: Given your history of skin allergies and the possibility of allergic rhinitis, it may be worthwhile to undergo allergy testing. Allergies can lead to inflammation and increased vascularity in the nasal mucosa, which can contribute to bleeding.

3. Blood Tests: To rule out any underlying hematological issues, such as clotting disorders or platelet dysfunction, your doctor may recommend blood tests. These tests can help assess your blood's ability to clot and identify any potential deficiencies.

4. Imaging Studies: If the ENT specialist suspects sinus involvement, imaging studies such as a CT scan of the sinuses may be recommended. This can help visualize any sinus infections or anatomical issues that could be contributing to your symptoms.

5. Management of Dryness: If dry air is a contributing factor, consider using a humidifier in your home, especially during the winter months. Saline nasal sprays can also help keep the nasal passages moist.

6. Avoiding Irritants: If you smoke or are exposed to secondhand smoke, consider reducing or eliminating this exposure, as it can irritate the nasal mucosa and exacerbate bleeding.

7. Monitoring Symptoms: Keep a diary of your symptoms, noting when the nosebleeds occur, their duration, and any associated symptoms (such as nasal congestion or facial pain). This information can be valuable for your healthcare provider.

In summary, while persistent nosebleeds can be alarming, they are often manageable with the right approach. It’s crucial to work closely with your healthcare provider to identify the underlying cause and develop an appropriate treatment plan. If you experience any sudden changes in your symptoms, such as increased frequency or severity of nosebleeds, or if you develop other concerning symptoms, seek medical attention promptly.

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