Common Nosebleeds: Nosebleeds (epistaxis) are rarely life threatening, and yet they can cause a fair amount of distress. It is estimated that 60% of people in the US experience at least one nosebleed in their lifetime, and 6% will seek medical intervention for it. The blood vessels inside the nose are protected by only a thin and delicate mucosal membrane, and any trauma or source of irritation may result in rupture of vessels and bleeding. Nosebleeds are most common in children younger than 10 years and adults 70 years or older. There are two types of nosebleeds: anterior (90 to 95% of cases, generally arising from vessels on the nasal septum just inside the nostrils, and more common in children), and posterior (arising from vessels in the back of the nose, often more severe). The purpose of this blog is to describe the common causes and treatment options for nasal bleeding.

Common Causes

The following are risk factors for nosebleeds:

• Chronic inflammation of the nose and sinuses (chronic rhinosinusitis)
• Improper use of nasal steroid sprays (can cause drying and crusting if sprayed directly onto the septum).
• Frequent or aggressive nose blowing
• Severe septal deviations which cause turbulent airflow on the deviated side which results in drying and crusting and sometimes bleeding of the nasal mucosa
• Cold, dry climate (central heating and air conditioning dries out the air and the nasal mucosa)
• Trauma (nose picking, nasal fractures, recent sinus surgery, etc.)
• Bleeding disorders (including the use of blood thinning medications – aspirin, plavix, warfarin, etc.)
• Alternative medicines that may increase risk include Ginseng, Ginkgo, and Garlic
• Alcoholism with associated liver disease (impairs platelet function)
• Kidney disease (also impairs platelet function)
• Thrombocytopenia (low platelet count) – can result from chemotherapy, blood disorders, or autoimmune conditions
• Hereditary Hemorrhagic Telangiectasia (HHT) – syndrome that causes frequent nosebleeds, often severe, and runs in families
• Nasal tumors – tend to cause one-sided nasal obstruction and frequent nosebleeds

Studies have shown that high blood pressure is not a direct cause of nosebleeds; however, it does make nosebleeds more severe and more difficult to control.

Treatment

It is possible to control most anterior nosebleeds with these simple steps:

• Lean forward to avoid swallowing blood
• Hold pressure on the bridge of the nose (just below where the nasal bones end) for a minimum of 10-15 minutes to promote clot formation
• Avoid blowing your nose for at least 24 hours to prevent rebleeding
• If nasal compression alone fails to control the bleeding, spray a nasal decongestant (such as Afrin®) into the side of the bleeding. This is a vasoconstrictor, and aids in stopping most minor nosebleeds
• Treat dryness and crusting of the anterior septum with gentle application of antibiotic ointment or Ayr gel using a cotton swab once the active bleeding has resolved

Frequent nosebleeds, particularly those recurring on the same side, can be a sign of a more serious condition and should be evaluated with nasal endoscopy by an experienced Rhinologist. Posterior nosebleeds arise from branches of arteries in the back of the nasal cavity. They tend to be more severe than anterior nosebleeds, and often require a trip to the Emergency Room for evaluation and management. While nasal packing is the traditional treatment for severe nosebleeds, studies have shown that early surgical intervention in the form of endoscopic clipping or cautery of the bleeding vessels under anesthesia saves both time and expense related to hospital care. Early surgical intervention is also associated with decreased pain and avoids days of uncomfortable nasal packing in the hospital setting.

When to Seek Medical Help?

Evaluation by a qualified physician is recommended if you experience any of the following:

• Frequent or recurring nosebleeds
• Nasal or facial trauma resulting in nasal hemorrhage
• Nasal bleeding that fails to respond to nasal compression
• Nasal obstruction associated with nosebleeds
• Nasal bleeding associated with rhinosinusitis (purulent nasal drainage, pressure or pain in the cheeks or forehead, fever, increased nasal congestion, etc.)

While most nosebleeds are easily managed, these situations may suggest a more serious etiology. Nasal endoscopy (visualizing the nasal cavities with a fiberoptic scope in the clinic setting) may help uncover the underlying cause of your nosebleeds. Trust your nasal care to a fellowship-trained Rhinologist who specializes in the diagnosis and treatment of nasal disorders. Call Houston Advanced Nose and Sinus at (713) 791-0700 or visit us online at www.houstonadvancedsinus.com to arrange for a consultation at one of our several office locations across the greater Houston area.