Nosebleeds and Lymph Node Swelling: Key Insights

Nosebleeds and Lymphatics

Hello, Dr.
Hsu.
On November 21, I noticed some slight blood streaks when I wiped my left nostril with tissue.
Upon closer inspection with a flashlight, I found that the mucosa in the anterior inferior part of the nasal septum was swollen and showed mild bleeding, while the right nostril did not have this issue.
My nasal septum is deviated to the left (I usually experience nasal congestion on the left side, which has been the case since childhood).
Later, I visited an ENT specialist at a clinic, who stated that there was a small wound on the mucosa in the anterior inferior part of the nasal septum and prescribed me an ointment to apply.
The doctor also performed a nasal endoscopy and examined my nasal cavity, throat, and larynx, all of which were normal.
An otoscopic examination of my ears also showed no issues.

On November 22, I continued to apply the medication and observed that the mucosa in the anterior part of the septum appeared less red.
However, on the morning of November 23, I noticed significant bleeding.
I had to wipe several times before the bleeding stopped.
I would like to know if this bleeding is simply due to the injury of the nasal mucosa or if there could be other underlying causes? (In the past year, I have experienced similar mild redness and swelling of the mucosa with slight bleeding two or three times, which resolved after applying medication.
This is the first time I have experienced such significant bleeding on November 23.)
Additionally, I showed the clinic doctor two enlarged lymph nodes located towards the back of my left neck, which I have noticed for over a year.
Their size has not changed significantly, approximately 0.5-1 cm.
Occasionally, they become slightly larger and harder but return to normal after some time.
The doctor noted that they felt a bit hard but reassured me that it was fine and suggested considering a biopsy.
I often feel that they are harder at times, but after a while, they feel softer and smaller.
I later went to Chang Gung Hospital for another ENT examination, where the doctor also performed an endoscopy and confirmed that there were no issues.
Upon palpation of the left neck lymph nodes, the doctor stated that they were likely just lymph nodes and, given that they have not changed significantly in size over the year, there is no need for excessive concern—just continuous observation.
I asked the doctor if further tests (ultrasound or biopsy) were necessary, and he said no, suggesting we wait until they increase in size.
I would like to ask if I need to pursue further examinations.
Additionally, I have recently experienced symptoms similar to a stiff neck on the left side, with pain when turning my head to the left or lifting it up.
Could this be related to the lymph nodes in my neck?
Another question: when we say that lymph nodes are enlarged and movable, does that mean that when I touch them, the skin can move while the lymph node itself remains stationary? Or is it something else?

greenchen, 30~39 year old female. Ask Date: 2012/11/23

Dr. Xu Jiazhen reply Otolaryngology

Regarding the situation of nasal mucosa being prone to bleeding, hello: This is quite common in outpatient settings.
Generally, as the physician in the clinic would handle it, one must be cautious of other issues in the nasopharynx that may be causing it.
If it is simply nasal bleeding, it is mostly due to allergic predisposition and scratching.
Of course, in rare cases, a hemangioma may also be observed, but most of the time, it will heal after medication and topical treatments.
As for the small lymph node in the posterior neck that you mentioned, if it continues to grow, it should be handled with caution.
If it remains at 0.5 cm, then observation is sufficient, as it is mostly due to non-specific inflammation.
If there is significant concern, excision and pathological examination can be performed, but most cases do not require this.
Sincerely, Hsu Chia-Chen.

Reply Date: 2012/11/23

More Info

Nosebleeds and lymph node swelling can be concerning symptoms, and understanding their potential causes and implications is crucial for appropriate management. Based on your description, it appears that you have experienced a few episodes of nosebleeds and have noticed swollen lymph nodes in your neck. Let's break down these issues.

Nosebleeds
Nosebleeds, or epistaxis, can occur for various reasons, including trauma, dry air, allergies, or underlying medical conditions. In your case, you mentioned that you have a deviated septum, which can contribute to nasal congestion and dryness, making the nasal mucosa more susceptible to injury. The small injury to the nasal mucosa you observed, along with the bleeding, is likely a result of this anatomical issue.
The fact that you have experienced similar episodes in the past suggests that this may not be an isolated incident but rather a recurring issue due to the chronic condition of your nasal anatomy. The bleeding you experienced on November 23, which was more significant than previous instances, could be attributed to a more substantial injury or irritation of the mucosa. It is essential to continue monitoring this situation. If the bleeding persists or worsens, or if you experience other symptoms such as significant pain, difficulty breathing, or recurrent infections, further evaluation may be warranted.

Lymph Node Swelling
Regarding the swollen lymph nodes in your neck, it is common for lymph nodes to swell in response to infections, inflammation, or other stimuli. The fact that you have had these lymph nodes for over a year without significant changes in size or consistency is reassuring. Lymph nodes that are firm but not fixed to underlying structures and that fluctuate in size can often be benign, particularly if they are associated with a recent infection or inflammation.

Your healthcare providers have performed examinations and have not found any alarming signs, which is a positive indicator. The recommendation to monitor the lymph nodes rather than pursue immediate biopsy or imaging is standard practice, especially when there are no concerning features. However, if you notice any changes—such as an increase in size, hardness, or the development of new symptoms—returning for further evaluation would be prudent.

Neck Pain and Lymph Nodes
As for the neck pain you are experiencing, it could be related to muscle strain, especially if you have been favoring one side due to the nasal issues or if you have had any recent physical activity that might have strained your neck muscles. While swollen lymph nodes can sometimes cause discomfort, they typically do not cause sharp pain unless there is significant inflammation or infection. If the pain persists or worsens, it would be wise to consult with a healthcare provider for a thorough evaluation.

Understanding Lymph Node Mobility
Regarding your question about lymph node mobility, lymph nodes can indeed be mobile or fixed. When a lymph node is described as "mobile," it means that it can be moved slightly under the skin when palpated, indicating that it is not adhered to surrounding tissues. This is generally a good sign, as fixed lymph nodes can sometimes suggest more serious conditions, such as malignancy. The ability to move the skin over the lymph node is a separate consideration; it indicates that the lymph node is not deeply embedded in surrounding tissues.

Conclusion
In summary, your nosebleeds appear to be related to your nasal anatomy, and the lymph nodes, while concerning, have not shown significant changes that warrant immediate intervention. Continue to monitor both conditions, and do not hesitate to seek further medical advice if new symptoms arise or if existing symptoms worsen. Regular follow-ups with your healthcare provider will help ensure that any potential issues are addressed promptly.

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