Dr David Lowinger MBBS FRACS Ear Nose & Throat Specialist Surgeon
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Adults

Bleeding nose

The nose has rich blood supply and hence trauma or injury to the face may cause nasal injury and bleeding. Nose bleed or epistaxis is blood loss from the tissues lining the nose and commonly occurs in one nostril only. Excess blood loss leads to dizziness, weakness, confusion, and fainting.

Nose bleeds are of two types, anterior and posterior. Anterior nose bleed accounts for about 90% of nosebleeds and it comes from blood vessel of the nasal septum. Capillaries and very small blood vessels may break and bleeding occurs. Posterior nose bleed occurs from an artery in the back part of the nose. The blood can also flow back into the throat or down into the stomach causing the individual to vomit blood. This type of nose bleed more commonly occurs in elderly people.

Causes

The most common cause of nosebleeds is trauma to the outer part of the nose caused from direct blow on the nose or inside of the nose caused from nose picking. Other predisposing factors include nasal or sinus infection, allergic and non-allergic rhinitis, high blood pressure, deviated nasal septum, nasal blockage by foreign body, nasal surgery, exposure to dry air for a long time, blood thinning medicines, vigorous nose blowing, and rarely nasal tumors.

Treatment

Self-care at home

  • Gently squeeze the soft part of the nose with wet cloth or tissue for 10 minutes
  • Apply ice pack over the nose
  • A nasal spray decongestant may be used to control bleeding.
  • Lean forward and breath through your mouth to prevent the blood from going back to the throat

Medical treatment

  • Chemical cauterization which involves sealing of the blood vessel with silver nitrate is the most efficient method for people with anterior nosebleeds
  • Nasal packings such as petroleum gauze, balloon nasal packs, and synthetic sponge packs may be used to promote clotting and stop the bleeding.
  • Posterior nose bleed can be very serious and requires hospitalization

Prevention

The following measures can help prevent nosebleeds:

  • Apply Vaseline regularly to prevent the nasal passages from becoming dry
  • Use a humidifier in the home
  • Use an antibiotic ointment or a saline nasal spray to keep the nasal passages moist
  • Avoid picking or blowing the nose too vigorously
  • If the nosebleed is because of underlying liver disease or chronic sinus condition, follow appropriate treatment for these conditions
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Royal Australasian College of Surgeons The Australian Society Of Otolaryngology Head And Neck Surgery Australian New Zealand Society of Paediatric Otorhinolaryngology (ANZSPO) The University of New South Wales The University of Sydney Harvard Medical School

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