Epistaxis (aka Nosebleeds)
Updated: Jul 6, 2020
What is epistaxis? It’s the doctor word for nosebleeds, because doctors have to have a special word for everything. It’s literally when, well, blood comes out of the nose. It’s a simple idea, but it can be a complex problem. Some causes of nosebleeds are obvious. When we operate on noses, they will bleed some. That’s expected, but we know it will be minor and temporary, because we caused the nosebleed. When trauma occurs to the nose, it may bleed. Usually, the bleeding is minor, but more severe cases of trauma may result in more severe nose bleeding. Still, it’s a simple concept. The more difficult situations are when the cause of the nosebleed is unknown.
Most nosebleeds are surgical, meaning that a procedure will stop the bleeding. Now, that procedure doesn’t always mean a trip to the operating room, but it will involve some form of cautery, surgery or packing to stop the bleeding. On physical exam, large vessels may be seen, particularly on the anterior septum, the wall that separates the two sides of the nose. These vessels may dilate, thus increasing blood flow to the nose. Occasionally, granulomas form. These are balls of dilated vessels that may stick out from the mucous. When these dilated vessels or granulomas get dry, they become brittle, and they may pop. Thus, the nosebleed occurs. Sometimes, a deviated septum may create turbulent air flow, which dries out the nose and causes bleeding. Sometimes, a sinus infection may result in minor bleeding.
Some nosebleeds are medical, meaning that controlling a medical condition may be necessary to stop serious bleeding and to prevent further bleeding. High blood pressure may cause nosebleeds, and it will often make nosebleeds difficult to stop. Clotting disorders are rare, but they can cause serious nose bleeding, and they are very difficult to stop. Liver disease, bone marrow disease, leukemias and lymphomas, as well as chemotherapy for cancer can result in serious and difficult to stop nosebleeds.
Generally, most minor nosebleeds can be treated at home with simple pressure. Pinching the nostrils and holding them closed for five to ten minutes will stop most nosebleeds in young people and healthy people. Older people and those with medical conditions may require the intervention of a medical provider, such as an emergency physician or an ENT physician. Over the counter decongestant sprays, like phenylephrine or oxymetazoline, will vasoconstrict, or squeeze the blood vessels shut, to control bleeding. Ice, or anything cold, is also a vasoconstrictor and can be placed on the nose to control bleeding. When surgical intervention is necessary, the bleeding vessels or granulomas can be cauterized under local anesthesia, or when severe, under general anesthesia in the operating room. Sometimes, it is prudent to pack the nose when a particular bleeding site cannot be found or cauterized.
Stopping the nosebleed is often the easy part. Preventing further nosebleeds is often more difficult. Keeping the nose moist is paramount. Nasal saline sprays should be used regularly to keep the nose from drying out. Heat is a vasodilator and will increase blood flow into the nose. Avoid hot foods and hot showers for several days after a nosebleed. Also avoid strenuous exercise. Only use decongestant nasal sprays for a few days to prevent rebound vasodilation. Rule out medical problems, check clotting studies and fix deviated septums.
Timothy A. Queen, MD is a board certified otolaryngologist and a fellowship trained otolaryngic allergist. He owns Advanced ENT & Allergy, in Oyster Point of Newport News. Please call 757-873-0338 for an appointment. You can also visit online at www.entallergy1.com.
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