Daily Nosebleeds
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Jonathan M. Lee, MD Assistant Professor, Dept. of Otorhinolaryngology Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA About the author: Dr. Jonathan Lee is Board Certified in Otolaryngology, Head & Neck Surgery. He received his undergraduate degree in Neurobiology at Harvard University, and he did his medical training at the University of Pennsylvania. His research work has been published in major medical journals and he has lectured at medical conventions throughout the country. He specializes in the medical and surgical management of a wide variety of ear, nose, and throat conditions, with a special focus on sinus disease and obstructive sleep apnea. https://www.pennmedicine.org/providers/profile/jonathan-m-lee |
As the weather gets colder, and people turn on the heat, I begin to see more and more patients with frequent nosebleeds. Nosebleeds, or epistaxis, occur in up to 60% of the population. While many episodes can be uncomplicated, nosebleeds can be severe enough to require trips to the emergency room, hospitalization, and sometimes surgery.
The vast majority of nosebleeds arise from the front part of your nasal septum, the wall that separates each side of your nasal cavity. Many different blood vessels converge on this area, which is why it is responsible for up to 90% of nosebleeds. When the temperature drops, and the heat turns on, the humidity in the home falls and this area is prone to drying out. When that happens, the fragile nasal lining can bleed when you sneeze, pick your nose, or blow your nose. In many patients, the bleeding can occur without any obvious triggers. Patients who take aspirin, advil, or other blood thinners are even more prone to nosebleeds.
In the event of a nosebleed, pinch both sides of your nose firmly between your thumb and index finger for at least ten minutes. Do not hold the bony part at the top of your nose, as that accomplishes little. To prevent frequent nosebleeds, nasal humidification is very important. For patients with frequent nosebleeds I recommend using nasal saline spray (two sprays to each nostril six times daily) and nasal saline gel (two applications to each side twice daily) for several weeks. This will moisturize the nasal lining and will often prevent the frequent nosebleeds from recurring.
While these strategies will work for uncomplicated nosebleeds, there are other more serious causes of nosebleeds that may need additional treatment. If you have a severe nosebleed that doesn’t respond to holding pressure, you may need to seek treatment to get it to stop. In some cases, patients may have enlarged blood vessels on the nasal septum that may benefit from cauterization with silver nitrate in the office.
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