Every day I cough up what looks like a scab with ugly mucous and blood

Posted by needtoknow @needtoknow, Feb 10, 2016

Every day I cough up what looks like a scab with ugly mucous and tiny amounts of blood. It seems to come from the back of my throat or nose. My doctor has seen the scab but does not see anything wrong. This, to me, seems really odd. Has anyone had this problem?

Because so much has been mentioned with regard to keeping moisture and hydration in mind, I am wondering if anyone has tried a facial steamer and/or used a humidifier consistently with any luck?

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@searchingforrelief

@vita61 I too have seen several several ENTs and a few GPs and none of them have known what it is. The most recent ENT did scope me and said I have irritated adenoids, that perhaps removing them MIGHT help, but not necessarily. I have found a couple of things that sometimes help dislodge the scabby thing: A hot shower, I usually let the water run over my face quite a lot, or eating something like a sandwich or other substantial meal. The worst though is when I become completely fixated on getting it out so I often just try to distract myself…

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@searchingforrelief
Depending upon your age, you probably don't have adenoids, but your problem sounds like it's in the same area as mine, which I've previously uploaded picures of the thumbnail sized "scab"

For years I was getting the scab about every 4-6 weeks until I had my deviated septum corrected by a local ENT 2 years ago.
After that I was getting the scabs every 3 days.
I had 2 MRIs and a CAT scan – I have really good insurance, but no indication of what was causing the scab.
At one point I took an antibiotic for 10-days, and the scab went away for 2 months … then it came back, though on a 4-5 day cycle.

I had a scab extracted and sent off to pathology, which came back with “Heavy Growth Staphylococcus Aureus”
After over a year of the local ENT trying to figure out what was going on, he decided to send me to the Specialist at Penn Medicine in Philadelphia – The Dr. you go to see when your local ENT isn’t able to find a solution.

He looked at my scans and history, and said yup I’ve seen this before … which was encouraging.
He said that I have a structural issue with my sinus that would be repairable, but felt that correcting the problem with the growth could be done without surgery.

As @nrd1 pointed out, your ciliary function (the little hairs that sweep mucous out) needs to be properly working. In my case, hydration and moisture helped to dislodge the scab, but did not help the underlying problem, which was a staph colonization causing a biofilm to develop. Note that this is a staph colonization, not a staph infection.

The solution for me was to give my body time to repair itself by breaking down the biofilm over a 21 day period. This gave the underlying tissue a chance to repair the cilia
• Clindamycin for 21 days
• Nasal Rinse twice a day – Distilled water (not tap!), saline, ½ tsp baby shampoo, Mupironcin, Budesonide
• Based on where my scab forms, in the upper nasopharynx where my adenoids would be, I must bend over so that when I rinse with the solution, it actually gets to the spot where the scab forms. I find it most convenient to do this in the morning when I shower. If I don’t bend over, then it’s not getting to the area.

Other notes:
• For the 1/2 Teaspoon of baby shampoo, I measured it at first, now I just squeeze in an approximate amount. It sounds crazy, but J&J Baby shampoo is what breaks down the biofilm — see picture of the rinse ingrediants. I also warm the rinse before I use it.
• Be sure to rinse the sinus rinse bottle every 2 weeks with 1/3 Hydrogen peroxide 2/3 Distilled water. And never use tap water.

Looking forward to hearing if this works for anyone else. I've a long history with this, so the notes above are an abbreviation that I wanted to quickly pass on to you and the others in this forum.

Be well 🙂

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@jfvero Thank you for sharing this concrete info, I will try what I can in my own and share it with my doctor. Really great that you were able to have your scab analyzed! I am 55 and had a rhinoplasty to correct a deviated septum 30 years ago. The goal was to improve breathing on my left side but it didn’t help and in fact over the decades my issues have gotten worse, leading to the blood/mucus clots. I did think it was odd that the ENT I saw a year ago said my adenoids were irritated. I have tried to explain where the clot forms as the spot where the nasal/sinus passage meets the throat. Do you know exactly where yours was located?

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@searchingforrelief @jfvero – yes it is all about the ciliary function and clearance. We all have Staph A in our nasal mucosa and skin. It normally does not cause an issue. Unless it stays in one spot and does not flow out. People who have had any type of nasal/sinus surgery will have disruption to their nasal mucosa/ciliary function. Especially a septal deviation surgery as the septum is formed in a way (deviated or not) that provides an airflow that gives proper humidification and resistance to the nasal mucosa and ciliary function. It actually takes away your natural humidification when you “fix” a deviated septum, because you are exposing the nasal cavity to more forced air. One of the risks, ENTs don’t warn about from nasal surgery is “dryness”. It’s much more than a simple dryness, however as that dryness is mucosal impairment. Something that might be a little annoying, is nothing that should have altered anatomy over. In the ENT community it is known that dry air is the, in their words is “death of ciliary” function. So why they would perform surgeries that expose the nasal cavity to more air that can not be properly humidified is beyond me. In saying that- just know there are many things that take place within the nasal cavity that you have control over, through diet, rest, and overall an effort into total health.
You have to get to the root cause. And the answer does not lie in manipulation and cutting of the tissue.

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Thank you again. Your posts are so helpful!

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@searchingforrelief

@jfvero Thank you for sharing this concrete info, I will try what I can in my own and share it with my doctor. Really great that you were able to have your scab analyzed! I am 55 and had a rhinoplasty to correct a deviated septum 30 years ago. The goal was to improve breathing on my left side but it didn’t help and in fact over the decades my issues have gotten worse, leading to the blood/mucus clots. I did think it was odd that the ENT I saw a year ago said my adenoids were irritated. I have tried to explain where the clot forms as the spot where the nasal/sinus passage meets the throat. Do you know exactly where yours was located?

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My scab is located where my adenoids would be – in the way back where the sinus meets up with the throat (my layman’s terms). If you look at the image I uploaded, you can see it in the picture. It’s the location for me that causes the need to bend over to reach hitting it with the nasal rinse. If I just do a regular rinse, it misses the spot.
Initially my local ENT looked for the spot with a stiff scope but said he didn't see anything. It wasn't until I coughed one of these up in the office that he pulled out the flexible scope and looked way in the back and saw the area.
also — I'm 59, and had the deviated septum repaid 2 years ago. It was a result of a football injury from my childhood, and I was never able to breath properly through my nose.

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Adenoid ‘pad’ is a term I hadn’t heard but that definitely looks like the spot. Can you imagine my most recent ENT first suggested I was describing a tonsil stone, luckily I had a photo of one of the scab/plugs next to a dime for scale. i said btwI actually succeeded in blowing one out my nose once, so clearly it wasn’t a tonsil stone.

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So I just tried adding ¼ teaspoon of the shampoo to my Neti pot solution and the pain was excruciating, it must be raw in there. Maybe I need some healing first! But I did do the saline and that was fine. I’m wondering if a product like Hibiclens would be helpful.

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Sorry to hear about the pain … just to be sure, was it J&J baby shampoo??? You can't use a regular shampoo
I also warm the neti bottle up in warm water for a few minutes

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Yep, J&J baby shampoo, but it is extremely irritated in there. I did warm the water to skin temp. It’s just me!

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@conniehar
your Question: are you using the oil and saline solution every day? I assume you don't use it at the same time (so 4 different times a day?) I may try the Ponaris emollient or Nozaid. Thanks!

I use the Oil (coldastop) every night now before sleep, and sesamoil during day (one time). Saline solution im slacking bit now, every 3 days maybe (in morning or at night). BUT i had no scabs till now since i started. (3 weeks now… and air is even more dry then when i started)

I whouldn't flush nose and put oil same time.

I started out with flushing nose in morning and night, and adding oil afterwards (5-10min later), when nose stops beeing runny.

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@dapapa @conniehar -keep in mind saline rinse can cause drying as well. Everyone will respond different depending on if your nasal mucosa is thick or thin. Saline is salt. Salt is drying on any skin. And the more you rinse, you are also rinsing away the good bacteria in your nose. If overdone, it can have the opposite effect that you are going for.

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