Epistaxis or nose bleeding is an especially common chronic nasal problem in adolescents and young adults. It is most commonly caused by a dry anterior nasal septum that has mucosa and blood vessels that crack and then bleed. It also is frequently caused by nasal trauma (nose picking) and may be increased by underlying medical conditions including hypertension, bleeding disorders, medications that cause anticoagulation or platelet abnormalities.
What are epistaxis symptoms?
Symptoms can vary with the season and may be brought on by changes in the weather. Heating and air-conditioning use may also create symptoms because of decreasing the humidity in the air. Nose bleeds may present as bleeding from the front of the nose and/or down the back of the throat.
How is epistaxis prevented and treated?
The most common treatment recommendation is to prevent drying in the nose using good hydration practices, a humidifier next to the bed if needed, and regular use of nasal saline and a topical agent such as vaseline, bacitracin or bactroban to prevent drying. Avoidance of nasal trauma/picking should also be encouraged.
To treat an anterior nosebleed, pressure with both fingers should be applied to each side of the lower nose directly over the anterior septum. Pressure should be held for 10 – 15 minutes. If bleeding resumes after releasing pressure, then it should be held for 15 – 30 minutes (without checking to see if the bleeding stops). If the bleeding resumes after holding for 30 minutes or continues down the back of the throat while pressure is being held, then the patient should go to the nearest urgent care or emergency room. Afrin/oxymetazoline is a vasoconstrictor (shrinks blood vessels in the nose) that may help decrease or control a nose bleed. You know you are holding pressure in the correct manner if you can’t breath through your nose.
When should my child see a doctor?
If your nose bleeds continue in spite of local treatment or persist for more than thirty minutes, it is appropriate to contact a physician. If the symptoms become overly frequent, it is also reasonable to see your physician.
Emergency treatment is rarely necessary except for extreme nose bleeds that persist in spite of treatment.
What happens during a physician visit?
The doctor will first obtain an extensive history about the child, the home environment, possible exposures, progression of symptoms, and risk factors for bleeding disorders. The physician will examine the skin, eyes, face and facial structures, ears, nose, and throat. In some cases, a nasal endoscopy may be performed. If active bleeding is occurring, the area may be cauterized and/or a nasal pack or nasal balloon placed. Nasal packing is usually left in place for 4 – 6 days. If no bleeding has occurred, but a prominent vessels is evident, the doctor may decide to cauterize the area to prevent future nosebleeds.
September 22, 2012 by Dr. David Bloom, MD