Nosebleeds (Epistaxis)

Nosebleeds, or epistaxis as it is known medically, is a very common occurence, and usually occurs from the front of the nose. This is due to the confluence of blood vessels (especially veins) in that area of the nose. About 80% of epistaxis is from this area, while the remaining 20% occur from other areas deeper inside the nose. The following are possible reasons for getting epistaxis:

• Trauma to the nose or face
• Allergic rhinitis/Severe seasonal allergies leading to inflamed nasal tissues
• Cold air exposure (nosebleeds are much more common in the winter)
• Taking blood thinners, such as aspirin or warfarin/Coumadin
• Elevated blood pressure
• Growths within the nose or sinuses
• Underlying bleeding tendency. This can include a specific condition known as Hereditary Hemorrhagic Telangiectasia (HHT for short), where there is an abnormality in the blood vessels, predisposing to frequent nosebleeds. This condition tends to run in families.

Most cases of epistaxis stop spontaneously with first aid measures, such as direct pressure to the front, soft parts of the nose, together with applying an ice pack to the nasal area. Sometimes emollients (Vaseline, medicated ointments from your physician) in the nose can heal the areas of bleeding tissue sites. In recurrent epistaxis, identification and simple local cautery of the bleeding areas can be performed in the doctor’s office. This will help in a majority of patients. In patients with persistent and severe arterial bleeding despite simple measures and even local packing, surgery may need to be performed in the OR to block off and control the 1 or 2 major blood vessel that most often contribute to nosebleeds. This is effective in over 90% of patients.

In patients with HHT, there are a number of local nasal procedures that can be performed to help to control and reduce the frequency of episodes of HHT epistaxis. Our center has published research on our own surgical technique to treat patients with HHT, and we are actively involved in researching new methods to treat HHT epistaxis.