Epistaxis

What Are the Common Causes of Epistaxis?

The most common causes of nosebleeds are nasal dryness, allergies, infection, and nose picking. However, some bleeds may occur because of a variety of other conditions, including:

• Vigorous nose blowing that ruptures superficial blood vessels
• Clotting disorders that run in families or are due to medications (especially aspirin and blood thinners)
• Trauma to the nose
• Uncontrolled high blood pressure
• Rarely, tumors (both malignant and nonmalignant — more common in older patients and smokers)

How Do I Prevent Rebleeding?

• Do not pick or blow your nose (sniffling is alright).
• Sneeze or cough with your mouth open.
• Do not strain or lift heavy weights.
• Avoid dryness by using saltwater (saline) sprays (e.g., Ocean nasal spray™ or Ayer™ sprays) five to 10 times a day. You can also use lubricating ointments (e.g., bactroban™ or vitamin ointments) two times a day — apply about the size of a pea on the end of your fingertip and then rub it up inside the nose.
• If cleared by your physician, stop using aspirin or products containing ibuprofen (use acetaminophen or Tylenol™ instead).
• Use a home or bedside humidifier.

What Are the Different Types of Nasal Packs?

If you have a serious nosebleed that could not be controlled with simple measures (e.g., nose pinching, nasal decongestants), then Dr. Pasha may use a nasal pack to control your bleeding. There are two main types of nasal packs that are performed during a procedure in the office or emergency room: dissolvable and nondissolvable.

The dissolvable packs (e.g., gelfoam) are typically utilized for moderate nosebleeds and contain substances that help clot blood. Dissolvable packs do not need to be removed and usually dissolve within five days to a few weeks.

Nondissolvable packs are reserved for more severe bleeds. They are typically removed three to five days after with insertions to allow a clot to form.

What if Nasal Packing Does Not Control My Nosebleeds or If They Recur?

If nasal packing does not control your bleeding, Dr. Pasha may consider cauterizing the bleeding site, tying off the vessels that enter the nose, or performing a septoplasty (lifting of the lining of the septum to cause scarring). These cases may be performed in the operating room.

Embolization may also be considered for serious bleeds. Embolization requires the use of an interventional radiologist. The radiologist enters your arterial system through your leg and then identifies the bleeding site with a special dye. If the vessel can be identified, substances that cause clotting of the vessel are placed to control the bleeding.

What Should I Expect When I Have a Nasal Pack Placed in My Nose?

Initially, nasal packs may be uncomfortable because you will be forced to breathe through your mouth, causing dryness. Your sense of smell and taste may also be temporarily impaired.

You may have some thin bloody secretions within the first few hours that may drain down the back of your throat or out your nose. Thin bloody secretions are normal and should not be confused with thicker active bleeding. Once a pack is placed, the irritated nose will secrete thin mucus that may become blood-stained because of the dry clotted blood within the nasal pack.

You may be prescribed antibiotics to prevent sinus infections — take the medication as prescribed.

What Kind of Diagnostic Tests May Be Ordered to Evaluate for Recurrent Epistaxis?

After a thorough physical exam, Dr. Pasha may schedule a nasal endoscopy in the office to attempt to identify bleeding sites, prominent vessels, or masses for recurrent epistaxis. He may also order blood work to evaluate for bleeding disorders. Occasionally, a CAT scan (a special type of X-ray) is helpful to evaluate for nasal masses.