Occasional Blood in Nasal Mucus: Causes and Concerns

Q: Occasional Blood in Nasal Mucus: Causes and Concerns

Hello： Based on your description, if you have already undergone a nasopharyngoscopy and been examined by multiple physicians, the likelihood of bleeding caused by nasopharyngeal cancer should be low. <br>If bleeding persists, you should seek medical attention to identify the blee

Occasional blood-tinged nasal mucus?

Hello, Doctor.
For the past six months, I've occasionally noticed a bit of blood in the mucus from my left nostril when I wake up in the morning.
I have specifically checked my phlegm, and there are no abnormalities.
I do not experience tinnitus, headaches, or other nasal secretions, but I do have some nasal congestion, which has been a recurring issue since childhood—sometimes it's clear, and sometimes it's blocked.
I've visited an otolaryngologist four times (both at a large hospital and at ENT clinics), where I've undergone a nasopharyngoscopy and otoscopy, as well as tympanometry.
The doctors have all said there are no abnormalities.
They noted that there are no polyps or tumors in the nasopharynx, but they mentioned that the left nasal septum is slightly deviated, and the inferior turbinate is somewhat hypertrophied.
Upon external examination, the turbinate mucosa appears red.
The doctors believe that the bleeding points are due to the hypertrophied mucosa of the inferior turbinate, which has long-term microvascular dilation and fragility, making it prone to bleeding due to weather changes, blood pressure fluctuations, or external forces.
They reassured me that it's not serious and mentioned that I have some allergies.
Each time I notice blood in my nasal mucus, I find that the turbinate mucosa is hypertrophied and particularly red, with occasional small wounds that may not always be obvious, but the area appears especially red, suggesting that the blood seeps from there.
Most of the time, it's just a small amount of blood oozing from the mucosa, and I tend to ignore it as it quickly resolves.
Applying some topical medication helps the wound heal, returning the area to its original red appearance.
This situation has been somewhat distressing for me, as I worry that there might be something that hasn't been checked.
What is your assessment, Doctor? Should I be concerned as the doctors have indicated, or is it indeed just due to the nasal structure making it prone to bleeding? Should I pursue further examinations or treatments? If so, what kind of tests would you recommend?

Fanrao de ren, 30~39 year old female. Ask Date: 2013/01/31

Dr. Zheng Jueyi reply Otolaryngology

Hello: Based on your description, if you have already undergone a nasopharyngoscopy and been examined by multiple physicians, the likelihood of bleeding caused by nasopharyngeal cancer should be low.
If bleeding persists, you should seek medical attention to identify the bleeding source.
Treatment options may include cauterization with medication or electrocautery, which can help improve the situation by causing atrophy of the microvessels near the bleeding site.
Additionally, it is important to observe for conditions such as hypertension, long-term use of nasal sprays, frequent nose-picking, habitual nose-blowing, or rubbing the nose.
If you do not have these habits and still experience frequent bleeding, you should consider getting a coagulation function test to check for any abnormalities that may lead to prolonged bleeding.
Wishing you safety and health.
Sincerely, Dr.
Jue-Yi Cheng, Head of the ENT Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2013/01/31

More Info

Understanding occasional blood in nasal mucus can be concerning, especially when it occurs frequently or is accompanied by other symptoms. Based on your description, it seems that you have been experiencing intermittent episodes of blood-streaked nasal mucus, particularly in the morning, without other alarming symptoms such as headaches, ear ringing, or significant nasal obstruction. You have also undergone several evaluations by ENT specialists, including nasal endoscopy and ear examinations, which have not revealed any significant abnormalities.

The presence of blood in nasal mucus can be attributed to several factors, and in your case, it appears to be related to the structural characteristics of your nasal anatomy. The bending of the nasal septum and the hypertrophy of the inferior turbinate (lower nasal concha) can lead to localized irritation and inflammation of the nasal mucosa. This irritation can cause the small blood vessels in the mucosa to become fragile and prone to rupture, especially in response to environmental factors such as dry air, changes in temperature, or even minor trauma from nasal blowing or picking.

In your situation, the fact that the bleeding is minimal and resolves quickly is reassuring. The red, inflamed appearance of the nasal mucosa you described, along with the occasional small wounds, suggests that your nasal lining is sensitive and may be reacting to allergens or irritants, which aligns with the diagnosis of allergic rhinitis. Allergic reactions can lead to increased blood flow to the nasal mucosa, causing it to become engorged and more susceptible to bleeding.

While your ENT specialists have indicated that there are no significant issues such as polyps or tumors, it is understandable that you may still feel anxious about the possibility of an undetected condition. If the bleeding persists or worsens, or if you develop new symptoms, it would be prudent to follow up with your healthcare provider. They may consider additional evaluations, such as imaging studies (like a CT scan of the sinuses) to rule out any underlying sinus issues or structural abnormalities that may not have been fully assessed during the endoscopy.

In terms of management, maintaining a humid environment, especially during dry seasons, can help reduce nasal irritation. Saline nasal sprays or rinses can also be beneficial in keeping the nasal passages moist and reducing the likelihood of bleeding. If allergies are a contributing factor, discussing the use of antihistamines or intranasal corticosteroids with your doctor may provide relief from symptoms and help reduce inflammation in the nasal mucosa.

In summary, while your symptoms may be related to anatomical variations and allergic reactions, it is essential to remain vigilant. Continue to monitor your symptoms, and do not hesitate to seek further medical advice if you have concerns. Your health and peace of mind are important, and addressing any lingering worries with your healthcare provider can help you feel more secure in your diagnosis and management plan.

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