Epistaxis

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Epistaxis or “nosebleeds” are very common and can occur for a variety of reasons. The inside lining of the nose is very vascular and has a rich blood supply, with blood vessels located very close to the surface. The vascular membrane that lines the nose can split, breaking a blood vessel, and causing nasal bleeding to occur. Nosebleeds are especially common in regions with dry climate. Installing humidifiers in the house, especially during winter, can reduce the occurrence of nosebleeds.

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Many people take NSAIDS such as Aspirin or Ibuprofen or are on blood thinners like Coumadin or Plavix. While these medications are necessary to treat certain medical conditions, they can also put you at risk for a nosebleed. They prevent your blood from clotting normally, which can cause a tiny burst blood vessel in the nose to continue bleeding. 

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If you experience recurrent episodes of brisk bleeding, then you need to be evaluated by an ear, nose and throat doctor. There can be other underlying reasons for recurrent nosebleeds, such as vascular abnormalities or tumors. An endoscopic exam and CT or MRI scan may be needed to further evaluate recurrent episodes of aggressive bleeding.

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How are Nosebleeds Treated?

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Using over-the-counter saline nasal spray or gel 3-4 times a day can help provide moisture to your nose, reducing your risk of nosebleeds. A humidifier in your bedroom can also help with providing moisture to the air you breathe. If the bleeding site can be identified, a simple nasal cautery can be performed in the office to treat your nosebleed. You should, however, go to the hospital for nosebleeds if you are having persistent bleeding that cannot be stopped by pinching the nose for 15 minutes, repeated bleeds over a short period of time, or a feeling light-headedness or dizziness.

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Most of the time, nosebleeds will resolve on their own. However, when the bleeding is aggressive and persists beyond the above measures, patients should see an ear, nose, and throat specialist. The specialist may need to treat the broken blood vessel to stop the bleeding. Sometimes this is done through chemical cautery, a minor procedure in which the physician slightly burns the area that’s bleeding and allows it to heal by keeping it moist. In some cases, packing the nasal cavity in the emergency room setting will stop the bleeding. If this is not enough, sometimes an operative procedure during which the problematic blood vessel is identified and clipped. In rare cases, embolization is recommended to stop the bleeding, in which a radiologist will perform an angiogram and inject particles into the blood vessels.

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