還未解決的問題

病患者男 - 35歲

周醫生你好，我的問題上年八月已經開展，到現在仍然未解決。希望你可以提供些議建。

1) Post-nasal drip problem started for quite some time, wasn't a big cause of concern

2) August 2017 – Started to spit out blood clots in the morning (once every 3 days), usually goes down the throat, but came down directly from nostril twice (both times from the left nostril). Sometimes I can clearly feel it dripping down to the throat from the nose.

3) October 24, 2017 – Saw first ENT, Endoscope - Nasopharnx looks normal, cannot locate source of bleeding, prescribed Nasonex, but problem persisted

4) November 3, 2017 – ENT arranged for MRI on - Findings were minor sinusitis in my Maxillary (Left+Right) and Splenoid (Left) sinuses, slightly deviated septum, no Malignancy. ENT noted some “liquid” trapped in left Maxillary sinus (shiny spot on MRI film).

5) November 8, 2017 – ENT prescribed 1-week of antibiotics (Augmentin 1000mg x twice daily) with no effect on condition

6) November 16, 2017 – Visited another ENT, Endoscope – diagnosis was Allergic Rhinitis, prescribed Nasal irrigation (Syringe type) + Nasonex twice daily + allergy medicine - post-nasal drip / blood blob issue was gone within that week of medication, mucus drained normally from my nose. Thought the problem was gone.

7) After finishing the week of medication, nasal congestion got progressively worst. First nasal drainage was thick and white, later became yellow in the left side (white on the other side), slight facial pain/pressure. Several days later, nasal congestion & facial pain was gone, but post-nasal drip returned. Shortly after, began to see small streaks of blood in the mucus from nose / post nasal drip on a daily basis.

8) December 19, 2017 – Endoscope again - Nasopharnx looks normal - still signs of Allergic Rhinitis

9) December 19, 2017 – Blood check for Anti-EBV IgA (NPC screening) - result was 2.3 (positive), immediately arranged biopsy

10) December 22, 2017 – Nasopharynx Biopsy (Multiple biopsies) was done at ENT’s clinic, medicine prescribed to stop bleeding from the minor op. Bleeding was under control in 3-4 days after the op.

11) December 29, 2017 – Pathology report of the biopsy came back – diagnosis was Chronic Nasopharyngitis, no Malignancy

12) Currently – There is brown mucus with small specs / streaks of blood on a daily/bi-daily basis. Not necessarily first thing in the morning, but soon after waking up. Sometimes small blood streak in post-nasal drip during the day. Ear became very sensitive to high-pitch sound, sometimes hear ringing noise. Sometimes feel uncomfortable swallowing saliva when post nasal drip becomes thick (does not interfere with eating or drinking).

周順傑醫生回覆:
2/5/2018

你好！你的鼻的不適，看來是鼻敏感和鼻竇炎引起，若能找出致敏原，治療效果可能會好些。至於鼻液有血和EBV病毒抗體呈陽性，是應該定期檢查鼻咽跟進的。

周順傑醫生
耳鼻喉科專科醫生

以上資料只供參考，不能作診症用途，
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