Treatment of nosebleeds (epistaxis)

Many people have had a nosebleed at least once: due to dry air, careless nose blowing, an injury, or a sharp increase in blood pressure. Epistaxis — is the medical name for a nosebleed. Most often, it passes quickly, but if such cases recur, last longer, or become more profuse, it is important to find out what exactly causes them.

At the «Oxford Medical» medical center, you can receive a consultation from an experienced otolaryngologist, undergo the necessary diagnostics, and receive individual recommendations. If you are concerned about recurrent nosebleeds, make an appointment — the doctor will conduct an examination and determine whether treatment is needed.

Nosebleeds are classified according to the location of the source and the features of their course.

Depending on the area of the nasal cavity from which the blood is discharged, the following types are distinguished:

• anterior — the source of the bleeding is located in the anterior sections of the nasal cavity, so the blood predominantly flows outward from one nostril;
• posterior — the source is located in the deeper sections of the nasal cavity, so the blood more often flows down the back wall of the pharynx;
• combined — the blood simultaneously flows outward through the nostrils and drains into the nasopharynx.

Anterior nosebleeds occur most often, whereas posterior and combined nosebleeds occur less frequently.

According to the nature of the course, the following types are distinguished:

• acute — begins suddenly, occurs rarely, and may have varying intensity;
• chronic, or recurrent nosebleed — manifests as periodic episodes that recur over a long period of time.

Recurrent episodes may differ in frequency, duration, and intensity, so it is important to pay attention to any changes and consult a doctor in a timely manner

Bleeding occurs due to damage to the blood vessels of the nasal mucosa. Most often, this is associated with dry air, injury, or inflammation, but recurrent episodes may be a consequence of general disorders in the body.

The main causes include:

• dry air and drying out of the mucous membrane;
• nasal injury, forceful nose blowing, or mechanical cleaning of the nasal passages;
• rhinitis, sinusitis, and other inflammatory diseases of the nose;
• prolonged use of vasoconstrictor drops;
• nasal polyps, deviation of the nasal septum;
• blood clotting disorders;
• taking anticoagulants and antiplatelet agents;
• hypertension and sharp fluctuations in blood pressure;
• acute infections, including some forms of hepatitis, which may be accompanied by blood clotting disorders.

Doctors at «Oxford Medical» recommend consulting an otolaryngologist if bleeding occurs regularly or without an obvious cause. In such cases, it is important to determine what exactly causes the damage to the blood vessels.

In most cases, bleeding from the nose stops quickly and does not pose a serious threat. Danger arises if it is profuse, does not stop for a long time, or regularly recurs. In such situations, significant blood loss is possible, which manifests as weakness, dizziness, paleness, rapid heartbeat, and a decrease in blood pressure.

Blood that flows down the back wall of the pharynx can enter the stomach and cause nausea or vomiting. Frequent nosebleeds require special attention, as they may be a sign of diseases of the nasal cavity, blood clotting disorders, or other health problems. Therefore, recurrent cases should not be left without diagnosis.

You should make an appointment for a consultation if:

• the bleeding lasts longer than 15–20 minutes despite the correct provision of first aid;
• bleeding from the nose occurs regularly or without an obvious cause;
• it appeared after an injury to the face or nose;
• pronounced weakness, dizziness, fainting, or difficulty breathing occur at the same time;
• the person takes medications that affect blood clotting or has a disorder of the coagulation system;
• the episodes are accompanied by other unusual symptoms, such as the appearance of bruises.

Doctors at «Oxford Medical» recommend not postponing an examination if the bleeding recurs. Timely diagnosis makes it possible to identify its cause and select effective treatment.

During the consultation, the otolaryngologist clarifies when the bleeding occurred, how long it lasted, whether such cases had occurred before, and what medications the patient is taking. The doctor also examines the nasal mucosa to determine the possible cause.

Depending on the situation, diagnosis of a nosebleed may include:

• anterior rhinoscopy or endoscopic examination of the nasal cavity;
• a complete blood count to assess hemoglobin and platelet levels;
• a coagulogram to check blood clotting;
• biochemical blood tests;
• X-ray of the skull, CT, or MRI if it is necessary to assess the structures of the nose and paranasal sinuses in detail.

The scope of the examination is determined individually. In cases of rare minor bleeding, additional tests may not be necessary, whereas recurrent or profuse bleeding requires a more thorough search for the cause.

Treatment depends on the cause that leads to recurrent episodes of bleeding. After the examination, the doctor determines what exactly leads to damage to the blood vessels and draws up an individual treatment plan. In some cases, medication therapy is sufficient, while in others, a minimally invasive or surgical intervention may be required.

The doctor may recommend:

• moisturizing agents and saline solutions — for dryness of the mucous membrane, the formation of crusts, and small cracks;
• medication therapy — for rhinitis, sinusitis, and other inflammatory diseases of the nose;
• coagulation of the blood vessel — if an area from which bleeding periodically occurs is detected during the examination;
• removal of polyps or neoplasms — if they injure the mucous membrane;
• surgical correction of the nasal septum — when its deformation causes constant irritation of the mucous membrane.

If recurrent bleeding is associated not with diseases of the nose but with systemic disorders, for example hypertension, blood diseases, or the use of anticoagulants, the otolaryngologist may recommend a consultation with a specialized specialist for the treatment of the underlying disease or correction of therapy

Prevention depends on the cause that led to the bleeding. After treatment, the doctor provides individual recommendations that help reduce the risk of recurrent episodes.

For prevention, it is recommended to:

• maintain indoor air humidity at 40–60%;
• use saline solutions or other products to moisturize the nasal mucosa if they were recommended by the doctor;
• avoid injuring the nasal mucosa and clean the nasal passages carefully;
• treat diseases of the nose and paranasal sinuses in a timely manner;
• follow the doctor’s recommendations after treatment.

If recurrent nosebleeds continue or new symptoms occur, it is advisable to consult an otolaryngologist again. This will help assess the effectiveness of treatment in a timely manner and, if necessary, adjust the further treatment strategy.

The cost of treatment depends on the required scope of the examination and the chosen strategy. First, the patient undergoes a consultation with an otolaryngologist, during which the doctor conducts an examination, prescribes additional tests if necessary, and determines the optimal treatment method. In some cases, medication therapy is sufficient, while in others, coagulation of the blood vessels or surgical intervention may be required.

Current prices for doctors’ consultations can be viewed here. To make an appointment with an ENT specialist in Kyiv, use the online appointment form or call the «Oxford Medical» contact center.

The information is for informational purposes and does not replace a doctor’s consultation.

Sources:

• American Academy of Otolaryngology
• National Center for Biotechnology Information
• British Rhinological Society