Nosebleeds/Epistaxis

Epistaxis is one of the most common complaints of patients seeing their primary care physician. It happens to nearly everyone. Most nosebleeds are minor and require little intervention; they typically resolve on their own without the need for major surgery. Despite the somewhat benign nature, these nosebleeds represent a significant burden to many patients in regards to their quality of life. Nosebleeds can be socially embarrassing, limit daily activities such as going to work and exercise, and are rarely life-threatening.

At Mount Sinai we treat everything from the common, everyday nose bleed to complex life-threatening nosebleeds. In addition we utilize a multidisciplinary approach by including allergists, neurologists, interventional radiologists, neurosurgeons and hematologists to help treat nosebleeds. We employ cutting edge techniques and instruments and additionally use novel medical therapies as well.

Causes of the Common Nosebleed

The common nosebleed can be attributed to a variety of causes and is usually multifactorial in nature. Some of these include elevated blood pressure, use of blood thinning medications, trauma to the inner lining of the nose, external trauma to the nose, use of intranasal drugs. During the cold, dry winter months, the most common cause is when the inner lining of the nose – or mucous membrane in the nose - becomes dry. When this lining is dry it can easily crack and tear, which exposes very tiny blood vessels that are close to the surface that will eventually bleed. This often occurs during the winter because cold air cannot hold as much moisture as warm air; therefore external surfaces such as the skin and lining of the nose tend to dry out.

Symptoms Associated with Nosebleeds

Numerous symptoms may occur during an episode of sinusitis. These include:

• Nasal congestion which manifests itself in difficulty or obstruction breathing through one side or both sides of the nose.
• Thick, purulent (yellow or green) drainage from the nose or from the back of the throat
• Decreased smell and taste
• Ear Pain
• Cough
• Facial pain or tenderness around the eyes, cheeks, and forehead
• Jaw aching or tooth pain
• Fatigue or chronic malaise
• Halitosis
• Fever

How to Prevent a Nosebleed

In order to prevent nosebleeds, the goal is to treat the factors that contribute them. The most common factor contributing to nose bleeds is dryness of the nose. This tends to happen primarily in the winter because cold air cannot hold as much moisture as warm air. In addition, many homes use forced-air heating systems that can decrease the moisture in the air even more. We often recommend continuous use of a home humidifier, especially in the bedroom.

We also recommend the use of nasal saline sprays throughout the day. These sprays are essentially salt water and serve to moisturize and lubricate the inner lining of the nose. The nasal saline sprays are very benign and it is nearly impossible to overdose on its use. They key to getting the sprays to work is proper administration of the sprays. Often patients direct the spray into the middle of the nose towards the septum. This is a mistake because it can actually cause or exacerbate trauma and worsen the bleeding. The tip of the bottle should actually be oriented slightly outward with a small amount of backwards head tilt.

How to Treat/Stop a Nosebleed

The majority of nosebleeds occur near the tip of the nose. This is due to the rich blood supply that this area gets and in addition it is the area that is often traumatized and is exposed to dry air. The best way to stop these bleeds is by applying direct pressure the area. Here is a step by step on how to do it.

First tilt your head forward. Use a cup or a pan to capture any blood spilling over. Leaning your head over will prevent you from swallowing large amounts of blood which can be very irritating to the gastrointestinal system and cause pain and nausea.

Apply direct pressure to the area by pinching your nose together just below the bridge of your nose. If you continue to bleed you need to slightly re-adjust the position of your fingers or increase the pressure you are applying.

Once the bleeding stops apply pressure for 5-10 minutes then release. It may take several rounds of this until the bleeding stops.

While pressure does most of the work I also advise patients to spray a small amount of Afrin nasal spray into the nose which can help constrict the blood vessels.

Applying a cold compress to the face and eyes can also constrict the blood vessels and decrease blood flow to the bleeding area. Avoid placing foreign objects such as tissue paper into the nose as it can be very irritating and if left for a prolonged amount of time it can actually cause sinus infections.

Persistent Nosebleeds

If the nosebleeds become more frequent in nature and do not resolve after 30 minutes of pressure, seek the advice of a medical professional. If the amount of bleeding is significant and enough to fill a Styrofoam cup, you should proceed to an urgent care facility or emergency room. It would be preferable to be examined by a doctor who specializes in Ear, Nose and Throat (otolaryngologist), who can diagnose the condition and, if needed, look deep inside the nose using a special camera or endoscope to both treat them problem and ensure there isn’t a more serious condition causing it.

Often times the site of bleeding can be easily seen and cauterized at the bedside. If you plan on seeing a physician for this issue make sure you describe the side where your nose bleeds are occurring and how often, if you are using any medications or herbal supplements, if you have elevated blood pressure or a history of nasal trauma.