Frequent Nosebleeds? When to See an ENT

Nosebleeds are common, and most are more alarming than dangerous. About 60% of people will have at least one nosebleed in their lifetime, and most stop on their own with simple at-home care. But if you are dealing with frequent nosebleeds, heavy bleeding, or nosebleeds that are hard to stop, it may be time to see an ear, nose, and throat (ENT) specialist. Here is what causes nosebleeds, how to stop one safely, and when a sinus surgeon can help.

What Causes Nosebleeds?

The inside of your nose is lined with delicate blood vessels that sit very close to the surface. When these vessels are irritated, dried out, or injured, they can break and bleed. The medical term for a nosebleed is epistaxis.

Common causes of nosebleeds include:

• Dry air: Heated indoor air in the fall and winter dries out the nasal lining, making it crack and bleed.
• Nose picking or rubbing: This is one of the most common causes, especially in children.
• Allergies and colds: Frequent blowing, sneezing, and inflammation irritate the nasal tissue.
• Sinus infections: Chronic sinusitis can leave the nasal lining swollen and fragile.
• Nasal sprays: Overuse or incorrect use of steroid or decongestant sprays can dry and damage the lining.
• Deviated septum: A crooked septum changes airflow through the nose, drying out one side and making it prone to bleeding.
• Injury: A blow to the face or nose can cause bleeding and may also indicate a broken nose.
• Blood thinners: Medications such as aspirin, warfarin, clopidogrel, and other anticoagulants make bleeding more likely and harder to stop.
• Underlying health conditions: High blood pressure, bleeding disorders, and conditions such as hereditary hemorrhagic telangiectasia (HHT) can contribute to recurring nosebleeds.

Anterior vs. Posterior Nosebleeds

Not all nosebleeds are the same. Your ENT doctor will want to know where the bleeding is coming from.

Anterior nosebleeds start in the front of the nose, usually on the septum. They make up the vast majority of nosebleeds, typically bleed from one nostril, and are usually easy to control at home.

Posterior nosebleeds start deeper in the back of the nose, where larger blood vessels are located. They are less common but can be heavier, may cause blood to run down the back of the throat, and often need medical treatment. They are more likely in older adults and people with high blood pressure or who take blood thinners.

How to Stop a Nosebleed at Home

Many people were taught to tilt their head back during a nosebleed, but this can cause you to swallow blood, which may lead to nausea or vomiting. Instead, follow these steps:

1. Sit up and lean slightly forward. This keeps blood from running down your throat.
2. Pinch the soft part of your nose just below the bony bridge, closing both nostrils.
3. Hold steady pressure for 10 to 15 minutes without letting go to check if the bleeding has stopped.
4. Breathe through your mouth and stay calm.
5. Apply a cold compress to the bridge of your nose if you like, which may help narrow the blood vessels.
6. Rest afterward. Avoid blowing your nose, bending over, or heavy lifting for several hours so the clot is not disturbed.

Tips to Prevent Nosebleeds

If you are prone to nosebleeds, a few simple habits can help keep the nasal lining healthy:

• Run a humidifier in your bedroom, especially during dry winter months.
• Use a saline nasal spray or gel to keep the inside of your nose moist.
• Apply a thin layer of petroleum jelly or nasal ointment just inside the nostrils.
• Avoid picking your nose and keep children's fingernails trimmed.
• Blow your nose gently, one nostril at a time.
• Aim nasal sprays toward the outer wall of the nostril, away from the septum.
• Manage allergies and keep your blood pressure under control.

When to See an ENT for Nosebleeds

Occasional nosebleeds are usually nothing to worry about. However, you should schedule an appointment with an ENT specialist if:

• You get nosebleeds several times a week or month
• Nosebleeds keep coming back from the same side
• You take blood thinners and have recurring bleeding
• You also have nasal congestion, sinus pressure, or trouble breathing through your nose
• Your child has frequent nosebleeds
• You bruise easily or bleed easily from other areas

Seek emergency care if a nosebleed lasts longer than 20 minutes despite steady pressure, the bleeding is very heavy, it follows a serious head or face injury, or you feel dizzy, weak, or have trouble breathing.

Nosebleed Treatment Options From an ENT

An ENT doctor can examine the inside of your nose, often with a small camera called an endoscope, to find the exact source of the bleeding and any underlying cause. Depending on what is found, treatment may include:

• Cauterization: A quick in-office procedure that seals the bleeding blood vessel using a chemical (such as silver nitrate) or gentle heat.
• Nasal packing: Special gauze, sponges, or inflatable devices placed in the nose to apply pressure and allow the vessel to heal.
• Medication review: Working with your other doctors to adjust medications that may be contributing to bleeding.
• Septoplasty: If a deviated septum is causing dryness and repeated bleeding, straightening it can improve airflow and reduce nosebleeds.
• Sinus treatment: Treating chronic sinusitis or nasal inflammation can help calm irritated tissue.
• Endoscopic surgery: For severe or posterior nosebleeds that do not respond to other treatments, a surgeon may tie off or seal the blood vessel responsible, such as the sphenopalatine artery.

Get Relief From Recurring Nosebleeds

Frequent nosebleeds are not something you have to live with. Whether your bleeding is caused by dry air, a deviated septum, chronic sinus problems, or another condition, an experienced ENT and sinus surgeon can pinpoint the cause and recommend the right treatment to stop it. If nosebleeds are disrupting your life or your child's, contact our office today to schedule a consultation.