Nosebleeds

Epistaxis (nose bleeding) is defined as bleeding from the nose, sinuses, or nasopharynx. Nosebleeds are defined as anterior (if they occur in the front of the nose) or posterior (if they happen in the back of the nose). Over 90% of nosebleeds are anterior. The septum contains blood vessels that can be easily damaged. The most common etiology of a nose bleed is local trauma/irritation to the nose, frequently exacerbated by dryness in the nose.

What Causes a Nosebleed?

• Allergies, infections, or dryness that cause itching and lead to picking the nose
• Vigorous nose blowing that ruptures superficial blood vessels
• Problems with bleeding caused by genetic or inherited clotting disorders (e.g., hemophilia or Von Willebrand’s disease)
• Medications that prevent blood clotting (e.g., anticoagulants like coumadin/warfarin, XARELTO®, or anti-inflammatory drugs like ibuprofen or aspirin)
• Fractures of the nose or the base of the skull (a nosebleed occurring after a head injury should raise suspicion of serious concern)
• Hereditary hemorrhagic telangiectasia, a disorder involving birthmark-like blood vessel growths inside the nose
• Tumors, both malignant (cancerous) and nonmalignant (benign), must be considered, particularly in older patients or smokers

Diagnosis is obtained by nasal endoscopy to directly visualize the nasal cavity to assess for the site and source of bleeding. Treatment options include direct pressure to the front of the nose and/or using nasal decongestant sprays (like oxymetazoline and phenylephrine). To help moisturize the nose, using nasal saline and a humidifier and applying ointments to the front of the nose are helpful. If local pressure doesn’t control a nose bleed, chemical cauterization with silver nitrate can be performed. Sometimes, nasal packing (either absorbable or non-absorbable) must be placed to exert more pressure. For complicated nosebleeds, other methods of treatment include surgical ligation or angiographic embolization of the bleeding vessel(s).