Severe Nosebleed (Epistaxis)

Nosebleeds, also known as epistaxis, are common issues that usually resolve on their own or are easily treated in a medical environment. For some patients, nosebleeds can be severe enough that further treatments are needed. At Mount Sinai, we have experience handling these cases of epistaxis.

Severe episodes of nosebleeds can be caused by:

  • Hereditary hemorrhagic telangiectasia (HHT), also known as Osler Weber Rendu syndrome, is a genetically inherited condition. People with HHT have small blood vessel malformations, known as telangiectasias, which affect the skin and mucosal membranes. Nosebleeds are the most common symptom; between 50 percent and 80 percent have recurrent bleeds.
  • Spontaneous epistaxis usually occurs in the fifth decade of life, and may be associated with hypertension or liver insufficiency. This type of nosebleed resolves without medical treatment; however, in some patients, the intensity or repetition of hemorrhages in a short period of time may require more invasive nosebleed treatment such as embolization.
  • Trauma
  • Tumors Occasionally bleeding from the nasal or oral cavities may be related to the presence of a tumor. If there is concern for this, further imaging such as computer tomography scan or magnetic resonance imaging to evaluate what is happening.
  • Vascular Malformations

Treatment Options

The first step in managing a severe nosebleed involves "packing" the nose, which should be performed by an appropriately trained physician. If this does not stop the bleeding, a procedure called embolization is performed by which the blood vessel supplying the inner lining of the nose is blocked.

If you experience severe blood loss from a nosebleed, it can cause serious anemia or cardiac dysfunction and reduced quality of life. At Mount Sinai, we can use embolization to treat severe, recurring nosebleeds that cannot be controlled by traditional means.

We may investigate the source of the bleeding via angiography. After we identify the vessels responsible for the bleeding, we can go back in through a catheter and block the vessels to stop the bleeding (embolization). In some cases, this technique can be lifesaving.