Epistaxis

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Epistaxis is the medical term for “nosebleed.” Most nosebleeds stop spontaneously, however, some may be more serious and even life threatening. Epistaxis may occur from the front of the nose (anterior epistaxis) or in the back of the nose (posterior epistaxis). Anterior nosebleeds are the most common and typically occur from the nasal septum (the wall that separates the left and right side of the nose). Deeper (posterior) nosebleeds are often more serious and require physician attendance.

FAQ

The most common cause of nosebleeds is nasal dryness, allergies, infection, and nose picking. Most nosebleeds stop spontaneously. 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) have to be considered, particularly in the older patient or in smokers.

Most nosebleeds may be controlled with the following steps:

  • Place a decongestant spray (such as Afrin™ or Neo-Synephrin™) directly into the nose or on a cotton and place in nose
  • Pinch as much of the front part of the nose together between your thumb and two fingers and press firmly toward the face
  • Hold for 5-10 minutes (timed with a clock)
  • Keep head higher than the level of the heart
  • Apply ice to nose and cheeks for 20 minutes (may use crushed ice in a plastic bag or washcloth)
  • If these conservative measures do not work then a doctor should see you as soon as possible. A nasal pack may be required to control the bleeding.
  • Do not pick or blow 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 (eg. Ocean nasal spray™ or Ayer™ sprays) 5-10 times a day and by using lubricating ointments (eg, bactroban™ or vitamin ointments) about the size of a pea on the end of your fingertip and then rub it up inside the nose two times a day
  • If cleared by your physician stop using aspirin or products containing ibuprofen (use acetaminophen or Tylenol™ instead)
  • Use a home or bedside humidifier

If the above conservative measures do not work then you should contact your doctor or report to the emergency room as soon as possible (A nasal pack may be required to control the bleeding).

Other reasons to go to the emergency room include:

  • If one feels faint or lightheaded from the bleeding
  • If bleeding is rapid or if blood loss is large
  • If bleeding begins by going down the back of the throat rather than the front

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 non-dissolvable.

The dissolvable packs (eg, gelfoam) are typically utilized for moderate nosebleeds. They typically contain substances that help clot blood. Dissolvable packs do not need to be removed and typically dissolve from 5 days to a few weeks.

Non-dissolvable packs are reserved for more severe bleeds. They are typically removed 3-5 days after with insertions to allow a clot to form.

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

The first few hours of placing a pack you may have some thin bloody secretions 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 mucous that may become blood stained because of the dry clotted blood within the nasal pack.

Often when packing is used (especially non-dissolving packs) antibiotics may be given to you to prevent sinus infections. Take the medication as prescribed.

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 done 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 then he or she 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.

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. Blood work may also be ordered to evaluate for bleeding disorders. Occasionally, a CAT scan (a special type of X-ray) may also be scheduled to evaluate for nasal masses.

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