Epistaxis (Nosebleeds)

by Dr. Christopher Chang, last modified on 11/25/11
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Epistaxis (also known as nosebleeds) which can happen at any time, most often occurs when the air suddenly turns cold and dry, especially in the winter season. The source of the nosebleeds usually is in the very front of the nose on the septum where the air entering the nose is at its most dry state. The septum is a wall that divides the right and left nasal cavities. Note that epistaxis is a particular problem in individuals with a deviated septum (correctable by a surgical procedure known as septoplasty) due to turbulent nasal airflow which creates a further drying effect (click here to read more about this situation). Sinus infections and allergies may also exacerbate nosebleeds.

What do I do if I have a nosebleed?

Pinch your nose firmly NOT over the bone, but just below it as shown below. One should keep the nose pinched for at least 10 minutes as that is how long it takes to create a scab. Should this measure fail, using a nasal decongestant such as Afrin may help before pinching the nose for another 10 minutes.

What do I do after a nosebleed?

There are some conservative measures one can try first before going to see a physician.

What options can our physicians provide for epistaxis?

When all these options have failed, a procedure called embolization can be performed of the vessels going to the nose. Embolization is when a catheter is threaded from an artery in the groin to the face where arteries going to the nose are deliberately clotted off preventing blood flow and hopefully permanently stopping the nosebleed from the inside (rather than outside as with cauterization or nasal packing). This procedure is performed by an interventional radiologist.

What are the differences among the different methods of epistaxis control?

Silver Nitrate Cauterization: This method uses a chemical called silver nitrate to create a superficial burn to the nasal lining where the bleeding is coming from. The silver nitrate is found on the tip of a wooden stick and rolled over the affected nasal lining after application of local anesthesia.

Electrocauterization: This method uses electricity to create a burn not only to the surface lining (as found with silver nitrate cauterization), but also deeper underneath the lining to create a more thorough burn and therefore scarring. This can be done after local anesthesia as well.

Nasal Packing: This method is when a tampon like device is inserted into the nose to exert continuous pressure over the site of bleeding. With continuous pressure, the blood vessels "collapse" and hopefully remains that way preventing future bleeds. The longer the packing stays in, the less the chance that a repeat nosebleed will occur. Ideally, 5 days of packing is optimal though 3 days is often sufficient.

Surgery: This invasive method is performed under general anesthesia whereby the nasal lining is lifted away and blood vessels cut. Typically, the surgery performed is called septoplasy since a septal deviation is also the basic reason why nosebleeds occur (read more on this here).

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