Blood Streaks in Saliva: ENT Insights and Next Steps

Q: Blood Streaks in Saliva: ENT Insights and Next Steps

Hi Chen： Hello, if you have already consulted multiple hospitals and clinics, and undergone examinations such as endoscopy and gastroscopy without any significant abnormalities found, it would be reasonable to observe the situation for now. <br>However, if you continue to see blo

Mysterious blood streaks?

I have never smoked, and I started drinking alcohol and chewing betel nut six months ago.
I accidentally discovered blood streaks in my saliva while clearing my throat after inhaling through my nose.
I visited a clinic and also saw an otolaryngologist at a hospital, where I underwent an endoscopic examination, and all results were normal.
Recently, in the past month, I experienced two incidents: once I noticed blood streaks on the wall of my throat, and another time, after clearing my throat again, I spat out a small amount of blood.
Overall, I have seen at least five or six otolaryngologists, both in clinics and large hospitals, and all have performed endoscopic examinations with normal results.
The doctors suggested that my nasal mucosa's microvessels might be fragile, which could lead to bleeding from forceful sneezing or throat clearing.
I also underwent an upper gastrointestinal endoscopy, which showed only mild gastroesophageal reflux.
The doctor advised me to monitor the situation unless the bleeding worsens or becomes more severe.
I would like to ask for your opinion, doctor.
Should I consider any further examinations, or is it sufficient to continue monitoring?

Chen, 30~39 year old female. Ask Date: 2014/10/14

Dr. Zheng Jueyi reply Otolaryngology

Hi Chen: Hello, if you have already consulted multiple hospitals and clinics, and undergone examinations such as endoscopy and gastroscopy without any significant abnormalities found, it would be reasonable to observe the situation for now.
However, if you continue to see blood streaks, another possibility could be originating from the lungs.
You may want to have a pulmonologist evaluate the situation further.
Wishing you peace and health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2014/10/14

More Info

Understanding blood streaks in saliva can be concerning, especially when they occur repeatedly. Based on your description, it seems that you have already taken significant steps to investigate the issue by consulting multiple ENT specialists and undergoing various examinations, including endoscopy and gastroscopy. The results have indicated that everything is normal, which is reassuring.

The presence of blood in saliva can arise from several sources, including the nasal passages, throat, or even the gastrointestinal tract. Given that you have experienced this after clearing your throat or blowing your nose, it is plausible that the blood could be originating from the nasal mucosa or the throat. As your ENT specialists suggested, it is possible that you have fragile blood vessels in your nasal mucosa, which can lead to minor bleeding when subjected to forceful actions like sneezing or clearing your throat.

Here are some considerations and next steps based on your situation:
1. Nasal Care: If the bleeding is indeed coming from the nasal mucosa, consider using a saline nasal spray or a humidifier to keep the nasal passages moist. This can help reduce the likelihood of bleeding due to dryness or irritation.

2. Gentle Techniques: When clearing your throat or blowing your nose, try to do so gently. Avoid forceful actions that could exacerbate the fragility of the blood vessels.

3. Monitoring Symptoms: Continue to monitor the frequency and severity of the blood streaks. If you notice an increase in the amount of blood, or if you experience other symptoms such as pain, difficulty swallowing, or persistent cough, it would be prudent to return to your healthcare provider for further evaluation.

4. Follow-Up with Specialists: If the bleeding persists or worsens, consider seeking a second opinion from another ENT specialist or a hematologist. They may perform additional tests to rule out any underlying bleeding disorders or vascular issues.

5. Gastroesophageal Reflux Disease (GERD): Since you mentioned having mild gastroesophageal reflux, it’s worth noting that GERD can sometimes contribute to throat irritation and bleeding. Ensure that you are following any dietary or lifestyle recommendations provided by your gastroenterologist to manage this condition effectively.

6. Avoiding Irritants: Since you are a non-smoker and do not consume betel nut or alcohol, you are already minimizing exposure to common irritants. However, be mindful of other potential irritants in your environment, such as strong odors, pollution, or allergens, which could exacerbate nasal or throat issues.

In conclusion, while the occasional presence of blood streaks in saliva can be alarming, it seems that you have taken appropriate steps to investigate the issue. Given the normal findings from your examinations, it may be reasonable to continue monitoring the situation while implementing some preventive measures. However, do not hesitate to seek further medical advice if your symptoms change or worsen. Your health and peace of mind are paramount, and staying proactive about your symptoms is essential.

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