Long-term nasal congestion could be a warning sign of a hidden "ticking time bomb" inside the body. A 17-year-old high school student in mainland China suffered from nasal congestion for three years. Initially, doctors treated it as common rhinitis, and the teenager himself didn't pay much attention because his symptoms seemed mild. But the condition never improved – it worsened. He experienced recurrent nosebleeds that severely affected his sleep and schoolwork. Finally, an endoscopic examination revealed the true culprit that had troubled him for years: a juvenile nasopharyngeal angiofibroma (JNA), a tumor with a high risk of life-threatening hemorrhage.
According to a report by mainland Chinese media Red Star News, Xiao Jie (a pseudonym), 17, first developed nasal congestion three years ago when he was a junior in middle school. At first, his family assumed it was just a cold from seasonal changes or classroom air conditioning. They tried nasal sprays and saline rinses, but his condition did not improve. Xiao Jie, worried about falling behind in his studies, kept telling his parents he could "manage." But after entering high school, his symptoms gradually worsened. He had to sleep with his mouth open, his snoring grew louder, and he often felt a sensation of fullness in his ears.
Over the following year and a half, his family took him to multiple doctors, receiving various diagnoses. Some doctors concluded he had a "deviated nasal septum" or "allergic rhinitis." A traditional Chinese medicine practitioner thought the problem stemmed from his spleen and stomach. One private clinic even recommended plasma ablation surgery. Later, a CT scan led another doctor to diagnose "residual adenoid tissue," suggesting it would naturally shrink after puberty. The doctor reassured the family, saying, "Boys have rich blood supplies; occasional nosebleeds are normal."
But Xiao Jie's body kept sending warning signals. His nasal congestion progressed from one side to both sides. The frequency of his nosebleeds increased from once a month to two or three times per week. Sometimes blood would flow backward from his posterior nostrils, causing him to choke and wake up in the middle of the night. During a physical education class, he suddenly experienced a massive nosebleed so severe that his teacher had to rush him to the hospital. The chronic discomfort had already severely impacted his studies and daily life.
Endoscopy Reveals a Vascular Tumor at the Skull Base
In March of this year, Xiao Jie's family brought him to the Department of Otorhinolaryngology (ENT) at Hangzhou First People's Hospital. Dr. Teng Yao-shu, the department's deputy director, carefully reviewed Xiao Jie's three-year medical history and immediately performed a nasal endoscopy. Under the lens, a purplish-red, smooth-surfaced mass was clearly visible in the right side of Xiao Jie's nasopharynx. The blood vessel markings were distinct, and the mass even pulsated slightly with his breathing. Teng determined that this was not rhinitis – it was a juvenile nasopharyngeal angiofibroma.
He explained that this type of tumor has an extremely rich blood supply. Its root can be deeply embedded in the skull base, surrounded by critical blood vessels and nerves. All the previous treatments – medications, nasal rinses – had not only been ineffective but may have inadvertently stimulated the tumor, increasing the risk of sudden massive bleeding. He also noted that on the earlier CT scan, which had been interpreted as "adenoid hypertrophy," a shadow in the nasopharynx was actually faintly visible – but it had not been given sufficient attention at the time.
Minimally Invasive Surgery Removes 80g Tumor: 'My Nose Is Unblocked'
After confirming the diagnosis, Teng quickly organized a multidisciplinary consultation. First, the neurosurgery team performed endovascular embolization to block the blood vessels feeding the tumor, causing it to become ischemic and shrink. Then, the ENT team performed an endoscopic-assisted minimally invasive resection to minimize surgical trauma and blood loss. After more than three hours of surgery, the tumor – weighing 80 grams (nearly 3 ounces) – was completely removed. There were no external incisions on Xiao Jie's face, and total blood loss was successfully kept under 100 milliliters.
Upon waking from anesthesia, Xiao Jie's first words were, "My nose is unblocked." It was the first time in three years he could breathe freely through his nose. Just three days after surgery, he was already able to walk, and his recovery has been progressing well. He will need regular follow-up visits with monitoring for at least five years to effectively prevent recurrence.
Adolescent Males at Highest Risk – Seek Medical Attention if 3 Symptoms Persist for 3 Months
Teng notes that juvenile nasopharyngeal angiofibroma most commonly affects males between the ages of 10 and 25. The initial symptom is typically unilateral, progressive nasal congestion. Because the progression is slow and insidious, it is easily misdiagnosed as rhinitis or adenoid hypertrophy. He specifically warns parents: if an adolescent male experiences any of the following warning signs, they should promptly seek evaluation by an ENT specialist:
- Persistent nasal congestion: Lasting more than 3 months, gradually worsening, and unresponsive to normal medications.
- Severe snoring: Needing to breathe through the mouth at night, with loud snoring.
- Recurrent nosebleeds: Usually unilateral, with increasing blood volume and longer time to stop bleeding.
- Other associated symptoms: Such as ear fullness, tinnitus, hearing loss, or even facial numbness and proptosis (bulging eyes).
Unilateral Nasal Congestion – Could It Be Cancer? 7 Warning Signs of Nasopharyngeal Carcinoma (NPC)
Unilateral nasal congestion that does not improve is never a minor issue. It can reflect a wide range of nasal and nasopharyngeal problems. Beyond juvenile nasopharyngeal angiofibroma, nasal congestion and nosebleeds can also be warning signs of nasopharyngeal carcinoma (NPC). According to Hong Kong's Department of Health, NPC is a cancer caused by the abnormal growth of nasopharyngeal cells. This malignant tumor is more common in men and is particularly prevalent in southern China, especially among people of Cantonese descent. Studies show that people living in coastal areas who regularly eat salted fish have a higher risk of developing NPC compared to those who do not. The main warning signs of NPC include:
- A painless lump in the neck
- Blood-stained nasal or throat discharge
- Hearing loss
- Partial deafness
- Tinnitus (ringing in the ears)
- Frequently recurring otitis media (middle ear infection)
- Nasal congestion (unilateral)
