Epistaxis (Nose Bleeds)

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Epistaxis is defined as acute bleeding from the nostril, nasal cavity or nasopharynx. It is generally a benign condition but can cause significant anxiety. In the majority of cases, the bleeding arises from the Kiesselbach plexus, an anastomotic network of vessels in the anterior part of the nasal septum. This area is commonly referred to as the "Little's area".

Sometimes, the bleeding can arise further back in the nose. These posterior bleeds are usually more severe and can be difficult to control.

What Causes Nosebleeds?

Local Causes:

Due to trauma (injury): nose picking, fractures of the nasal bones or following nasal surgery

Due to tumours: these may be benign tumours such as polyps, which can sometimes bleed. In rare instances, bleeding can also be a sign of nasopharyngeal cancers.

Degeneration of blood vessels: posterior nose bleeds of advancing age are thought to be due to vessel degeneration.

Systemic Causes:

Medication: patients on anti-coagulation medication

Familial hereditary telangiectasia (Osler's disease): this is a systemic disease in which the endothelial layer of the blood vessels is deficient, making them weak and prone to bleeding.

Patients with hypertension do not have epistaxis more frequently, but when they do, the bleeding tends to be more severe.

How do I manage Nose Bleeds?

First-Aid at Home:

• Remember to stay calm. Most nose bleeds are benign and will stop with simple measures.

• Sit upright and lean your head forward. Tilting your head backward will cause you to swallow the blood.

• Pinch your nose for about 10 minutes. This simple application of pressure should stop most bleeds.

• Once the bleeding stops, try to prevent any further irritation to the nose for the next 24 hours. Avoid sneezing, blowing your nose, picking your nose or straining.

• Avoid prolonged exposure to dry air. Using a humidifier and avoiding air-conditioned environments will help keep the nasal mucosa from drying out and triggering more bleeding.

Medical Treatment:

For nosebleeds that do not stop or for those who get frequent troublesome nosebleeds, your ENT specialist may perform the following:

• Electrical or chemical cautery (with silver nitrate) of the offending vessel.

• Nasal packs and balloons may be required in more complicated cases. They act by applying direct pressure inside the nostril to help stop the bleeding.

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