Nosebleeds (Epistaxis)

Epistaxis, commonly referred to as nosebleeds is a condition that can cause bleeding from one or both nostrils. The causes associated with epistaxis include dry air, nose picking, trauma, respiratory infection, allergies, sinusitis, high blood pressure, and more. Approximately 60% of people worldwide experience nosebleeds (epistaxis) at some point in their lives. The condition is common in children and older adults. Epistaxis is most common in dry weather, during colder months when the air is dry. Also, hot weather can dilate blood vessels in the nose, making them more prone to bleeding. 

Mostly, nosebleeds happen from one nostril, but they can affect both nostrils at a time. Various factors lead to epistaxis, including:

• Dry Air: The most common factor that leads to nosebleeds is dry air. It dries out the nasal membrane making them crusty or cracked resulting in nosebleeds. 

• Trauma: A direct blow or injury to the nose, resulting from sports, accidents or nose picking can result in epistaxis. 

• Structural Abnormalities: Nosebleeds may also result due to structural abnormalities like deviated nasal septum, nasal polyps, or tumours.

• Infection: Upper respiratory infections that make you keep sneezing, coughing, or blowing the nose may result in epistaxis. 

• Medications: Certain medicines can also increase the risk of epistaxis. Medicines like aspirin, warfarin, etc reduce the blood’s ability to clot, making them more prone to bleed. 

• High Blood Pressure: High blood pressure is also linked to nosebleeds, it can cause vessels inside the nose to burst, especially if they are already irritated or dried.

• Overuse of Nasal Sprays: Overuse of decongestant sprays or steroid nasal sprays can cause rebound congestion, thin the nasal mucosa, and result in epistaxis. 

• Alcohol Use & Smoking: Alcohol use and smoking can dilate blood vessels and irritate the nasal lining leading to epistaxis. 

There are two types of epistaxis, based on the location of the bleeding within the nasal cavity. 

• Anterior Epistaxis: Anterior epistaxis is the most common type. The bleeding starts in the front of the nose, on the lower part of the septum. Anterior epistaxis is usually caused by minor trauma, nose picking, dry air, etc.

• Posterior Epistaxis: Posterior epistaxis is less common but more severe. It occurs deep inside the nose. A bleed in the larger blood vessels in the back of the nose causes this. This may result from existing medical conditions like high blood pressure, etc.

Epistaxis is usually treated by an ENT specialist. The diagnosis involves a combination of physical examination, medical history review, and some blood tests. 

An ENT specialist may ask about the length (in minutes) of the nosebleeds, the amount of blood that came out, the frequency of nosebleeds, if bleeding involves both the nostrils and more. Additionally, the specialist may also inquire about the medications you take, family history, use of alcohol, etc to diagnose the condition better.

The ENT specialist, to determine the source of bleeding, uses an endoscope to see inside the nasal passage. Additionally, the doctor may also recommend tests including:

• CT Scan: Help identify potential issues, if the cause is unclear. 

• Blood Test: To check for bleeding disorders. 

• Direct Pressure: Treatment involves leaning forward and applying firm pressure continuously for 10-15 minutes. Applying direct pressure helps stop nose bleeding. 

• Nasal Packing: The specialist inserts nasal sponges, foam, or inflatable latex balloons to create pressure on the site of bleeding. The inserts may be left for 24 to 48 hours.

• Cauterization: The medical procedure involves applying a chemical substance to seal the blood vessel and stop bleeding. 

• Surgery: Treatment through surgery involves repairing a broken nose or correcting a deviated septum. 

• Ligation: The treatment procedure involves tying the bleeding blood vessel to stop bleeding.

• Use nose drops and nasal sprays to keep the nasal passage dry as it prevents it from drying out.
• Avoid blowing the nose forcefully.
• Refrain from putting anything hard in the nose, including fingers.
• Quit smoking & avoid excessive alcohol as it can dry and irritate the blood vessels.
• Wear protective gear during sports to keep safe from nose injuries.
• Maintain proper hydration to prevent nostrils from cracking and bleeding.
• Apply ice (covered cloth) to help constrict blood vessels and stop bleeding.
• Use a humidifier at home to add moisture to the air.