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Heads Up to Understanding Nosebleeds

Publish Date: 10/21/2015

A sudden nosebleed can be quite alarming. Often they arise from a small grouping of blood vessels in the front part of the septum, the wall that separates the right and left sides of the nose. This area of the nose is the first to receive the inhaled air, causing dryness to develop and producing crusts that can lead to bleeding.

However, in middle-aged and older adults, a nosebleed may also begin deeper in the nose's interior. The origin of this nose bleed is much less common -- it may be caused by hardened arteries or high blood pressure. This type of nosebleed begins without warning and is often difficult to stop – it requires a specialist's help.

According to Jay Piccirillo, MD, FACS, Washington University professor of otolaryngology -- head and neck surgery, “Since most nosebleeds are from the front part of the nose, the immediate treatment is to put pressure on that area of the nose. This is accomplished by holding the nose closed with firm pressure using the thumb and index finger. The blood will usually clot in 8-10 minutes, so apply the pressure for that long, keeping your head higher than the level of your heart.

Sitting upright will reduce the blood pressure to the veins of the nose. It is a common misconception to tilt your head back to stop a nosebleed.

Spraying the interior of the nose with a decongestant spray, like Afrin® or Neosynephrine®, decreases the size of the blood vessels and helps to control bleeding. Repeating the spray and pressure every 10 minutes should control most nosebleeds. If you are taking anticoagulant medications – including aspirin – this will lengthen the clotting time.”

Nosebleeds can be more common in winter months --because the cold, dry air can aggravate the situation. Keep in mind that forceful blowing of the nose should be avoided. Moisturizing gel ointments and saline sprays may also be helpful. If bleeding persists, packing of the nose may be necessary if other measures are not successful.

Dr. Piccirillo warns, “The common practice of picking at crusts within the nose should be avoided as this traumatizes the delicate lining -- producing more crusts and scars. This habit may even lead to a hole in the septum, further worsening the nosebleeds. There is also the risk of introducing bacteria into the nose that can lead to infections.”

Other less common causes of nosebleeds are excessive use of nose sprays, nasal surgery, tumors, infections, systemic diseases, blood clotting disorders and trauma.

If you find that nose bleeds are a recurrent problem, Dr. Piccirillo can offer other treatment options, such as cauterization, to control this embarrassing and spontaneous occurrence.

Patients are seen at three convenient locations:

• Center for Advanced Medicine – Ear, Nose and Throat Center. 4921 Parkview Place, 11th floor, Suite A. Call 314-362-7509 for an appointment.

• Center 40 Building, 1600 S. Brentwood Blvd., Suite 600. Call 314-747-3813 for an appointment.

• West County ENT, 605 Old Ballas Road, Suite 124. Call 314-362-7509 for an appointment.

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Jay F. Piccirillo
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