Nose Bleeds

Medically known as epistaxis, nose bleeds occur when the tiny blood vessels of the nose
break due to trauma, dryness or inflammation. Nosebleeds are extremely common, and
most people will have several throughout their lifetime. They are more common in
children under 10 years of age due to the common obsession of putting things,
especially their fingers inside the nose. It is also very common in those between the
ages of 50 and 80.

There are 2 Types of Nosebleeds

1. Anterior nosebleed – These are the most common type and occur when the
   bleeding is coming from the front part of the nose. The location of the bleed is
   usually seen on exam and bleeding is often easily resolved with pressure.
2. Posterior nosebleeds – These start father back in the nasal cavity and often
   flow down the back of the throat, causing significant distress and frequently
   some nausea and vomiting from all the blood going into the stomach. Posterior
   nosebleeds are more difficult to treat and usually require emergency attention as
   they can cause a large amount of blood loss.

Most isolated events of epistaxis are caused by irritation from blowing the nose or other
trauma such as being scrapped by a fingernail. Direct blows to the nose as in sports or
an altercation will also frequently cause the nose to bleed. Dry air that is common
during the winter months when indoor heaters dry out the house or in naturally dry
climates can also lead to frequent nosebleed as the nasal mucosa dries out and the skin
easily cracks open and bleeds.

An ENT evaluation is often necessary when nosebleeds become frequent and/or difficult
to stop.

Frequent or recurring nosebleeds may be caused by

• Allergies
• Chronic infection
• Dryness
• Clotting disorders such as hemophilia or von Willebrand’s disease
• Uncontrolled high blood pressure
• Medications that thin the blood
• Hereditary hemorrhagic telangiectasia (abnormal growths of blood vessels)
• Tumors – malignant and benign should always be ruled out, especially in smokers

If blood starts to trickle out the front of one or both nostrils, it is likely an anterior nosebleed.

To stop an anterior nosebleed, follow these steps:

1. Stay calm – anxiety and agitation will cause more bleeding especially if crying starts to cause nasal drainage and sniffling.
2. Sit up and keep the head higher than the heart
3. Lean forward slightly to keep the blood from draining into the back of the throat.
4. Gently blow any clotted blood out of the nose.
5. Spray the nose with a nasal decongestant; oxymetazoline is the active ingredient in most over-the-counter decongestant sprays.
6. Apply pressure to the front of the nose (the soft part) with thumb and index finger for at least 5-10 minutes.
7. Seek medical care if the bleeding still doesn’t stop or quickly recurs. Packing or cauterizing (burning off the ends of the capillaries with an electrical current or silver nitrate) may be necessary to stop the bleeding.

To prevent anterior nosebleeds, avoid traumatizing the nasal passageways and keep the mucosa moist. This can be done by placing a light coating of saline gel, petroleum jelly, or an antibiotic ointment on the end of a Q-tip and gently applying it inside the nostril, especially on the middle portion of the nose (the septum). 

If blood starts flowing immediately down the back of your throat, it is may be a posterior nosebleed. Direct pressure to the front of the nose does not stop the bleeding and decongestant nasal sprays are not likely to work. It is important to seek immediate medical attention to prevent significant blood loss if you think you are having a posterior nosebleed.

Posterior nosebleeds are more common in older people and those with a history of nasal or sinus surgery or injury to the nose or face. Treatment typically includes cautery and/or packing the nose with a special gauze, tampon, or an inflatable balloon that applies pressure to the bleeding vessels.

If you experience frequent nose bleeds, make an appointment to see one of our ENT Specialists today.