EARS & HEARING
Nosebleeds (Epistaxis) can occur at any age but are most common in children aged 2-10 years and adults aged 50-80 years. Nosebleeds are divided into two types, depending on whether the bleeding is coming from the front (anterior) or back (posterior) of the nose. Anterior bleeds are by far more common and are mostly the exclusive kind in otherwise healthy children. Anterior bleeds occur most commonly from a broken blood vessel on the septum just beyond the opening of the nose. This area is laden with an extensive network of interconnected blood vessels that can bleed out of proportion to their size. They are exposed to trauma from the use of tissue to rub your nose when it’s running or itchy, fingers that inadvertently scratch it, and drying from heat or poor airflow especially in the dryer winter months. Other factors that may cause one person’s nose to bleed more easily or heavily include the use of medications that make vessels more fragile or prevent blood from clotting. Other medical conditions may contribute as well. Anterior nose bleeds may be one sided and recurrent, usually on the same side, or bilateral. The location of an anterior nosebleed can often, but not always, be identified by an ear nose and throat doctor. Posterior nose bleeds are more likely to start and stop in fits. They may be brief and heavy or prolonged and eventually peter out before starting back up. They are often more difficult to identify or treat. History of facial fracture and trauma can be associated with more serious causes of nose bleeds.
Many simple nose bleeds respond to pressure like other minor cuts. Here are some tips for managing many nose bleeds.
- Stay calm, or help a young child stay calm. A person who is agitated may bleed more profusely than someone who’s been reassured and supported.
- Sit upright and lean your head forward so the blood won’t drain in the back of the throat.
- Gently blow any clotted blood out of the nose. Spray a nasal decongestant in the nose, if available.
- Using the thumb and index finger, pinch all the soft parts of the nose (both sides of the nostrils); note that compressing the bones at the top of your nose, between your eyes, will not accomplish much.
- Do not place gauze, tissue, or cotton inside your nose.
- Hold the position for five to ten minutes. If it’s still bleeding, hold it again for an additional 10 minutes.
- Place an ice pack on the back of the neck to help cool the blood flow from your neck to your nose; blood will clot more quickly when it is cool.
- Use of bacitracin or triple antibiotic ointment on the septum, for two weeks can help the area from drying out and rebleeding. It also helps the tissue heal after it has been cauterized (see below).
- Use of a vaporizer and saline nasal spray can also prevent drying.
- One of the most common causes of rebleeding is trying to remove the irritating scab that may form. One suggestion is to tap the outside of the nose rather than touch the scab.
If the bleeding stops using the above techniques but keeps restarting, you should strongly consider seeing an otolaryngologist. When the bleeding does not stop, especially if you faint or feel like you might pass out, you should seek emergency treatment. If it is possible to wait, however, an otolaryngologist has the advantage of specialized instruments to localize the bleeding and treat the specific site with cautery or hemostatic materials. When that fails and bleeding persists, the nose sometimes needs to be packed. In the rare case that the bleeding is posterior, locating and managing the nose bleed can be more difficult and often requires more specialized techniques.
These are many of the causes:
- Allergies, infections, or dryness that cause itching and lead to picking of the nose.
- Vigorous nose-blowing that ruptures superficial blood vessels.
- Clotting disorders that run in families or are due to medications.
- Drugs (such as anticoagulants or anti-inflammatories).
- Fractures of the nose or the base of the skull. Head injuries that cause nosebleeds should be regarded seriously.
- Hereditary hemorrhagic telangiectasia, a disorder involving a blood vessel growth similar to a birthmark in the back of the nose.
- Tumors, both malignant and nonmalignant, have to be considered, particularly in the older patient or in smokers.