Nosebleeds by Roheen Raithatha, M.D.
Epistaxis is defined as bleeding from the nose, sinuses, or nasopharynx. Nose bleeds are defined as anterior (if they occur in the front of the nose) or posterior (if they occur in the back of the nose). Over 90% of nose bleeds are anterior. The most common etiology of a nose bleed is local trauma/irritation to the nose, oftentimes exacerbated by dryness in the nose. Other causes include septal deviation, septal perforation, inflammatory diseases, tumors, use of anticoagulants, blood disorders, hereditary hemorrhagic telangiectasia, and foreign bodies. Diagnosis is obtained by nasal endoscopy to directly visualize the nasal cavity to assess for the site and source of bleeding. Treatment options include direct pressure to the front of the nose and/or using nasal decongestant sprays (like oxymetazoline and phenylephrine). To help moisturize the nose, using nasal saline and a humidifier and applying ointments to the front of the nose are helpful. If local pressure doesn’t control a nose bleed, chemical cauterization with silver nitrate can be performed. Sometimes, nasal packing (either absorbable or non-absorbable) must be placed to exert more pressure. For complicated nose bleeds, other methods of treatment include surgical ligation or angiographic embolization of the bleeding vessel(s).