What causes blood tinted crust in nose while sneezing?

Question

Hello doctor,

I have had post-nasal drip for the last three months. It causes me to cough up mucus from my throat, which is sometimes thick, bloody, or cloudy. I am also experiencing bloody, crusty issues in my nose along with sneezing. I am not sick, have no fever or aches, and do not feel unwell. I just want to stop the mucus (which sometimes chokes me) and address the bloody, crusty nose and sneezing. I tried Zyrtec (Cetirizine) and Flonase (Fluticasone), but neither helped. I am afraid to take Benadryl (Diphenhydramine) because of the other medications I take for sleep and anxiety. What other suggestions do you have?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

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

Our approach will differ depending on whether the bleeding is from the upper or lower airways. In the first scenario, we will provide nasal lubricants and sprays to see if the bleeding stops. In the second scenario, we will need to rule out cough and chest problems. In either case, a nasal endoscopy with a laryngoscopy is essential. Do you have blood-stained mucus from the nose or throat every single day?

Please get back to us with all the details so that we can assist you.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

Considering that you have this issue coming from both the nose and the throat, we need to rule out the following:

First, we need to examine the nose and larynx to check if there is anything causing the 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 these are clear, the bloody sputum could be arising from the lower airways. Next, I would recommend some blood tests to rule out any bleeding disorders. Please get a complete blood count, including hemoglobin, total leukocyte counts, prothrombin time (with INR), activated partial thromboplastin time, platelet counts, and fibrin degradation products. I am afraid you will need to make an appointment with an ENT specialist when it is safe to go outside. Temporarily, I suggest you stop using the Flonase spray, as steroid nasal sprays can 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 inside the nostrils three times daily. Insert the nozzle into the nostril, close the nostril, and squeeze a small amount. This will keep the mucosa oily and moist, preventing crusting and dryness. Before doing this, you can take steam inhalation through the nose and mouth alternately. I recommend doing steam inhalation first, followed by the nasal drops, and then applying the cream. Continue with the antihistamine (Zyrtec) for a couple of weeks. Add a PPI (proton pump inhibitor) - either Protonix or Raciper. If using Pantoprazole (Protonix), take 40 mg twice daily on an empty stomach. If using Esomeprazole, take 40 mg once daily on an empty stomach for a few weeks. The PPI will help prevent excessive throat mucus. If you want to reduce the mucus, take NAC (N-acetyl cysteine) up to 1200 mg daily (in two doses of 600 mg each). NAC is available in a dispersible format, which you need to mix with water and drink. Since you do not have any other symptoms, I would not start you on an antibiotic for now. However, we need to find the cause of the bleeding. A laryngoscopy and nasal endoscopy are definitely needed. We may also request a chest X-ray if the upper parts do not reveal anything.

I hope you are satisfied with my answer. For further queries, you can consult me at icliniq.

Thank you.