I am having blood tinted crust in nose while sneezing. Please advise.

Hello,

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Are the pictures you shared nasal snort or phlegm from throat (attachment remoed to protect patient identity)? Do you have any difficulty in swallowing or breathing? Is there any cough? Any chest pain? Do you have wheezing? Is there any recurrent bleeding in your nasal cavities? Do you smoke or drink?

Our approach would differ if the bleeding is from the upper airways and if it is from the lower. In the first scenario, we shall give you some nasal lubricant creams with the sprays and see if the bleeding stops. In the second we will have to rule out cough and chest problems. In either case, a nasal endoscopy with a laryngoscopy is essential. Do you have such blood-stained mucus from the nose/throat every single day? Do revert back to us with all details so that we can help you.

Hi,

Welcome back to icliniq.com.

Considering that you have this issue coming from the nose as well as the throat, we need to rule out the following things.

First, we need to examine the nose and larynx to check if there is anything that is causing bleeding. Rhinitis and sinusitis can cause nasal bleeding. Any ulcer in the throat or back of the tongue can cause phlegm with a blood tinge. If the above two are alright the bloody sputum could be arising from the lower airways. Nextly I would recommend some blood tests to rule out any bleeding diathesis. Please get a complete blood count inclusive of hemoglobin, total leukocyte counts, prothrombin time (with INR), activated partial thromboplastin time, platelet counts, and fibrin degradation product. I am afraid you will have to take an appointment with an ENT as and when it is safe to go outside. Temporarily, I would suggest you stop the Flonase spray temporarily. Steroid nasal sprays are known to cause nasal bleeding as a side effect.

Get plain saline nasal drops and instill a few drops in each nostril four to five times daily. Apply an antibiotic cream like Soframycin or Mupirocin thrice daily inside the nostrils, keep the nozzle inside, close the nostrils, and squeeze a small amount. This will keep the mucosa oily and moist preventing crusting and dryness. Before you do the above you can take some steam inhalation through the nose and through the mouth alternately. I would say, steam then the nose drops, and finally the cream. Continue with the antihistaminic (Zyrtec) for a couple of weeks. Add a PPI - Protonix or Raciper. If Pantoprazole - Protonix (then take 40 mg twice daily on an empty stomach). If Esomeprazole 40 (Raciper or Nexium 40) then take 40 mg once daily on an empty stomach for a few weeks. The PPI will prevent excessive throat mucus. If you want to lighten the mucus, take NAC (N-Acetyl Cysteine) up to 1200 mg daily (you can take it in 2 doses of 600 mg each. NAC is available in a dispersible format which you need to mix in water and drink off. Considering you do not have any other symptoms, I would not start you on an antibiotic for now. But I must reiterate that we need to find the cause of the bleeding. A laryngoscopy and nasal endoscopy are definitely needed. We may ask for a chest radiograph also if the upper parts do not reveal anything. Do revert back to me if you need further support. Happy to help you.