Nosebleeds – November 2013

Nosebleeds (medical term “epistaxis,” from the Greek “to drip”) are the most frustrating maladies treated by Ear, Nose and Throat (ENT) physicians. Many of my ENT colleagues call nosebleeds “the bane of their existence.” While this may be true, since nosebleeds seem to occur in the wee hours of the night, I know they are much worse for the patient suffering them than for the doctor treating them. Newer technology has resulted in many treatments for even the worst nosebleeds, and I am always happy to help these miserable patients in my clinic.

Aggravating Factors

 There are numerous factors that cause nosebleeds. Here are the basic factors:

  1. Blood thinners:  many of use medication, or take supplements that improve our health, but cause a process called “anticoagulation,” which simply means that they cause loss of the ability of the blood to clot. Many of the more common offenders are: aspirin (acetylsalicylic acid), omega-3 fish oil, Coumadin (Warfarin) and Plavix (prescription blood thinners), other supplements including, but not limited to ginseng, garlic, ginko biloba, St. Johns Wort.
  2. “Health supplements” of many varieties are guilty of causing some blood thinning.
  3. High Blood Pressure:  “hypertension” is associated with a heightened risk of bleeding from the nose. This is common sense, as the pipe with the higher pressure is likely to crack and leak.
  4. Dry climate:  dry, arid air, especially air that contains pollutants, such as we often have here in Colorado can cause the nose membranes to crack.
  5. Nose picking:  nasty habit that tears up the nasal membrane, and prevents raw areas from healing.
  6. Older age:  tissues become dry and fragile as we age.
  7. Genetic and hereditary problems:  we know of many disorders causing the blood to lack clotting factors, or cause abnormal growth of small vessels.

Treatment

Ninety percent of nosebleeds are reachable with the tip of your finger on a structure called the nasal septum (partition wall between nasal passage). The vessels in this area are very fragile and close to the surface. The other 10% are much further back, or high on the side wall of the nose near the sinus openings.

Treatment of an active bleed in my office includes:

  • Cleaning the area of any clots
  • Application of medication on a piece of cotton that numbs the membrane and shrinks the vessels temporarily
  • Direct micro-cauterization using a microscope or fiber-optic scope.

On rare occasions, I will have to place a temporary pack over the bleeding site for a day or two to protect the cautery from the dry air or injury.

Patients with severe nasal bleeding that can’t be managed as above are very rarely taken to minor surgery where the bleeding can be better controlled. A relatively new technique called selective arterial embolization (placing a catheter in the major blood vessel feeding the nasal area with blood, and injecting a “glue-like” substance to plug the feeding vessel) can be used when all else fails, and is very successful.

Prevention

The words “an ounce of prevention is worth a pound of cure” were never so true as they are pertaining to nosebleeds. There are many factors that cause nosebleeds that we CAN control (see “Aggravating Factors”). Keep your nose moist if you live in a dry climate using nasal saline sprays. KY jelly, or various nasal lubricants can be purchased without a prescription. Blow your nose gently without twisting it from side to side. Don’t pick or dig. Be cautious about the use of “supplements” as many offer little true help, and many have serious side effects, like easy bleeding. If you are on blood thinners for a medical condition, keep close track of the dosage and monitor your blood clotting through blood tests if possible. Monitor your blood pressure and treat it if it elevates.

Even if one abides by all of the above, nosebleeds do happen. Most urgent care clinics are able to treat minor nosebleeds. I am always happy to see patients in my office with this condition.

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