What is the Most Common Cause of Epistaxis (Nosebleeds)?

What you’ll learn:

• Why certain situations and conditions make individuals more susceptible to experiencing nosebleeds
• Where within the nasal passages nosebleeds occur and leading factors that contribute
• How to stop a nosebleed and the preventive measures to minimize the occurrence of nosebleeds

By understanding the leading cause of nose bleeds and mastering effective strategies for prevention and management, you can regain a sense of control over your nasal health. Join us in this episode to equip yourself with the insights you need to tackle nose bleeds head-on.

Don’t miss this informative discussion – it might just provide the answers you’ve been seeking. Subscribe to our podcast, leave a review, and stay tuned for more valuable episodes on nasal health. Your well-being matters to us!

Listen to the audio version below.

Audio Transcript:

Dr. Reddy: Hey guys, this is Dr. Reddy. I’m joined here by Dr. Smith. We’re part of NJENT, and today’s topic is nosebleeds. The medical term for nosebleeds is called epistaxis. And so we’re gonna go over some brief overview on this topic and how we treat it. So we’ll get started with first, what is a nosebleed? What is epistaxis. Would you like to go over that?

Dr. Smith: Yeah, so patients come in very frequently to us with either recurrent nosebleeds, meaning they’re getting them frequently or they got one really bad one and ended up in either their emergency room or their urgent care center. So a nosebleed in general is just blood or bleeding coming from the nose. Now most often it comes from the front of the nose, but sometimes it can actually just trigger and go posterior in the nose. So sometimes people start coughing or spitting up blood and the blood that when it starts to come up, you know, can even have some clots so it can be dark. in nature as well, and kind of gelatinous, or it can be thin and bright red, which is very common for like little anterior nosebleeds. And so bleeding can be from a whole host of sources and we’ll talk about them, kind of what can cause them. We’ll go over what to do when you get one to try to like avoid needing further care and then kind of what are some alarming or warning signs that may indicate that you may need some care. You want to talk about that?

Dr. Reddy: Yeah, so you kind of alluded to anterior nosebleeds. So there’s two main kinds of nosebleeds. One is called anterior, and the other one’s called posterior. And anterior nosebleeds are what most people get. Usually it’s milder nosebleeds. And there’s a particular area on the front part of your nose called the Kesselblock’s plexus, and it’s a confluence of where a lot of different major blood vessels kind of come together. and the frequent side of nosebleeds. And usually these types of nosebleeds can be addressed easier. And then you have the more severe nosebleeds oftentimes which are way in the back part of the nose called posterior nosebleeds. And those are much more difficult to kind of control. But before we even talk about how to control nosebleeds, let’s go over what may cause a nosebleed.

Dr. Smith: Sure, so some very common causes. A lot of times we get kids that come in the wintertime, it’s cold, it’s dry, and the heat flips on in the house, it dries the humidity out even more, and then they start to get, or they wake up with nosebleeds, or they get them frequently at school. And so that’s cool, dry air, it can be an irritant and cause some drying in the blood vessels. Most commonly, as Dr. Reddy was talking about with the anterior circulation, right on the anterior part of the septum, which is the most kind of part closest to the outside world You may even have some a little bit of exposure, some of the blood vessels going inside the nasal cavity, but they’re almost always on the septum in the front of the nose, which is the thing that divides the two sides. And those little blood vessels that come together, they can get dried out, they can come close to the surface, and they can get a little tiny hole in them. And so cold, dry air, lack of humidity can be an irritant that causes those to open up. Allergies can cause very prominent blood vessels in the front of the nose. So some people with a lot of allergies, the blood vessels get really large and engorged and those could swell and then lead to nosebleeds as well. So sometimes we start to see them in the allergy season but probably not as common because humidity starts to increase as well during those allergy times. The other thing that can cause them are medications. And so sometimes we see patients who are on, older patients who may be on blood thinning medications. or even some other things that can, even some supplements like ginseng and garlic and ginkgo biloba and some other things like fish oil can thin the blood and make you vitamin E and make it more likely that you may bleed as well. So blood thinning medications are a cause, dryness we talked about, allergies we talked about. And then one thing we always talk about with kids and parents is, you know, what we call digital trauma, picking your nose. So, you know, a lot of people pick their nose and sometimes they may get like a little scab and may inadvertently pick that off or may scratch the nose and cause a bleed to start occurring. And so those are probably the most common cause, but of course, like trauma, getting hit in the nose can cause it, breaking your nose can cause a nosebleed. But the most common ones that we tend to see are due to like kind of like the cold, dry air and blood thinning medications.

Dr. Reddy: And other, you know, there’s rare causes of bleeding noses. Some of the rare things that we find is growths or tumors inside of the nose. So that’s one of the first things we try to rule out is to make sure that there isn’t like a nasal polyp or an inverted papilloma or some very rare- Any sort of new growth, yeah. Yeah, rare cases of nasal cavity cancers, things like that, that can rarely cause nosebleeds. But, you know, once we kind of do the initial evaluation, we will sometimes consider additional workup. In some cases, if you have recurrent nosebleeds, there might be even a coagulation problem or a bleeding disorder that might be causing this. So there’s a bleeding disorder called Von Willebrand’s disease and other relatively rare bleeding disorders that we sometimes get blood work for to rule those kinds of bleeding disorders out. Sometimes we get imaging studies too, to make sure there isn’t any… growths that might be causing it, again, very rare. But once we kind of do the workup and we look at the risk factors, there’s multiple treatment options. Most treatment options really depend, is really trying to address any of the underlying problem for what’s even causing the nosebleed. But let’s go over a couple treatment options for nosebleeds.

Dr. Smith: Sure, so one thing we talk about, especially with the kind of the more simple things, humidification in the room. saline sprays and saline gels to try to help humidify the inside of the nasal cavity and Vaseline and even like a mild antibiotic ointment like Basitracin can be used inside the nasal cavity to increase the humidification as well and so those things can then often you know be the assistance if someone’s on a lot of you know Motrin or Advil we want to make sure that maybe we try to come off of those NSAID medications. So sometimes things like Motrin and Advil can trigger these. And so we start to think about maybe substituting some of that with something like a Tylenol or something else that may give somebody some pain relief if they need it. So those are kind of just the more of the simple things that we look at to try to correct. And then of course, for treating nosebleeds, so those are more prevention and then treating it. as long as it’s not, you know, we’ve done a formal evaluation and done a well, a history and physical, and we see that there’s no ulcers or tumors or anything like that, then we can start addressing the prominence of the blood vessels. And usually, um, you know, affrin or decongestant spray can be used. Uh, a lot of times if you have a larger bleed and you’re at home, most of those things can be controlled, um, with just some pressure. And so, um, Afrin soaked on a cotton ball or tissue or paper towel even can be used which you soak a little bit of that decongestant on the cotton ball or the tissue, stick it in the nose and hold pressure. Most commonly we see people hold pressure up here on the nasal bones, but really you want to hold pressure on the lower part of the nose and you want to pinch pretty firm and hard so that you’re not able to blow any air out and suck any air in. And you just want to let things kind of clot off. You don’t want to keep… dabbing it and blowing and getting all those clots out of there because that’s your body’s trying to stop the bleed. So hold pressure, we normally recommend 10-15 minutes. If it’s still bleeding, try to get some of that afferent or decongestant spray if you have it on hand and usually all of our patients that get recurrent nosebleeds, we try to tell them to keep these things on hand so they have them should they need it. And then lastly, there are some like hemostatic or blood clotting agents that can even be used. They make these little sticks that you can buy, the stick inside the nasal cavity, which have like a congealing kind of starch in them that help clot off the blood a little bit easier. And even, you know, nasal packs, they make small little tiny ones. And some people have even used things like tampons and other things and bunched up paper towels to try to get the clot off. But usually if it’s that bad, hopefully at that point, you’re coming in and seeing one of us or seeking medical attention before really packing the nasal cavity. Do you wanna talk about any of the other like kind of easy control things or what we do in the office?

Dr. Reddy: So if all of these conservative measures don’t do the trick or you’re having persistent or recurrent nose bleeds despite this, and there’s all sorts of different procedures that we can potentially do to decrease bleeding. So one option is a simple chemical cauterization of any dilated blood vessel in your nose. It might be the source of the bleeding. And the most common chemical for that is something called silver nitrate. That’s where we just kind of put a little silver nitrate on the inside of a dilated blood vessel to kind of shrink it and to seal it off. The other option is using an electrical cauterization. So something called bovie electrocautery or bipolar electrocautery. where you’re sealing the blood vessels with an electrical device. And that can be done either in the office or it can be done with some anesthesia. In rare cases where there’s persistent severe nosebleeds despite conservative measures like this, there is a procedure called endoscopic sphenopalatine artery ligation, which is a fancy term for sealing off one of the major blood vessels that goes into the nose. And this can be done endoscopically, meaning with a small little camera inside of your nose, minimally invasively. And that has a high likelihood of stopping future nosebleeds. And then the other kind of almost last resort that we very rarely have to use for severe nosebleeds is angioembolization. And that’s when we refer you to a particular type of doctor. an interventional radiologist or a neuro interventional doctor that actually goes through the groin or through your arm, through the blood vessels up into your head and embolizes some of the blood vessels that may be causing the bleeding. That’s a very rare thing that we have to do, but also has a high success rate. Anything else you’d like to add?

Dr. Smith: No, and you know, very commonly we see patients that come in that have had severe nosebleeds from the emergency rooms. They end up with nasal packing that gets put in. Some of those packs are more sponge-like and some of them are more balloon type of materials that go into the nasal cavity. There are all sorts of dissolvable materials too that can be placed into the nasal cavity to help stop bleeds. And there are even some like newer chemicals that can be used in the emergency setting to help. stop nosebleeds as well. So, you know, nosebleeds, you know, typically have a stopping point, but then what to do with them afterwards is when you kind of need someone like us. So if you, if you go in and you end up getting packed or you get one of these special chemicals that help you stop bleeding, one of them is called TXA, you know, often you need follow up, you need someone to evaluate. And that’s when you see us. And we try to cauterize that spot and do those therapies that Dr. Reddy was just talking about, you know, packing Sure, it can be uncomfortable, but often it’s necessary to help put some pressure against that blood vessel. And sometimes even just the pack itself can stop and control some of these pretty bad bleeds. And with the packing, you know, there’s a whole bunch of different instructions. And normally we try to keep them in for several days and try to get them out because we realize that they’re uncomfortable. So we try not to leave them in there too long. So other than that, there’s not a whole lot as far as anything else to look for nosebleeds, but you do want to make sure that if it’s an ongoing or persistent issue, the one thing that we always do, you know, caution people is if it’s going on and on and on, please, you know, make sure you get evaluated and don’t just keep putting it off because it could be something like a small blood vessel growth or something that easily be fixed, but you just don’t want to miss or avoid or ignore something, you know, more, more concerning.

Dr. Reddy: Great. I think that’s all we have for today. Thank you for joining us, and we’ll see you on the next show. All right, make sure you guys subscribe to our podcast, like us and be sure to tune in for more. All right, that’s