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NOSE BLEEDS (EPISTAXIS)

Condition and Symptoms

Mrs Bentley often sees patients with recurrent nosebleeds (epistaxis). These can be dramatic and frightening, fortunately, most nosebleeds are not serious, although sometimes medical intervention may be necessary.

Most nosebleeds do not have an easily identifiable cause. However, trauma to the nose is a very common cause of nosebleeds. Nosebleeds can be caused by trauma to the outside of the nose from a blow to the face or trauma to the inside of the nose from nose picking. Other conditions that predispose a person to nosebleeds include:

  • exposure to warm, dry air for prolonged periods of time

  • nasal and sinus infections

  • allergic rhinitis

  • nasal foreign body (object stuck in the nose)

  • vigorous nose blowing

  • nasal surgery

  • deviated or perforated nasal septum

  • cocaine use

Less commonly, an underlying disease process or taking certain medications may cause a nosebleed or make it more difficult to control.

  • Inability of the blood to clot is most often due to blood-thinning medications such as warfarin (Coumadin), clopidogrel (Plavix), nonsteroidal anti-inflammatory drugs (NSAIDs), or aspirin.

  • Topical nasal medications, such as corticosteroids and antihistamines, may sometimes lead to nosebleeds.

  • Liver disease, chronic alcohol abusekidney disease, platelet disorders and inherited blood clotting disorders can also interfere with blood clotting and predispose to nosebleeds.

  • Vascular malformations in the nose and nasal tumours are rare causes of nosebleeds.

  • High blood pressure may contribute to bleeding, but is rarely the sole reason for a nosebleed. It is often the anxiety associated with the nosebleed that leads to the elevation in blood pressure.

Treatment

If the person is not at high risk of having a serious underlying cause, treatment options for recurrent epistaxis may include:

  • Topical treatment with an antiseptic preparation.

  • Silver Nitrate nasal cautery; this can be performed in the clinic at the initial consultation. This is very well tolerated and is performed under a local anaesthetic spray to numb the area.

  • Bipolar/monopolar/laser cautery:

 This is often used in an operating theatre, and normally requires an anaesthetic. 

  • Artery Clipping: 

In severe cases one of the main blood vessels in the nose can be clipped (tied off), so that the bleeding is reduced. This is performed endoscopically ( so no external scars). It takes about 30 mins and most people can go home on the same day.