Since the nose heats, filters, and humidifies inspired air very effectively, a rich blood supply to the area is required. One in every seven people in the United States will suffer a nosebleed sometime in life. Children aged 2-10 and adults aged 50-80 are the most likely to get nosebleeds.
Nosebleeds are categorized based on where they originate, and are described as either anterior (originating from the front of the nose) or posterior (originating from the back of the nose).
- Anterior nosebleeds make up more than 90% of all nosebleeds and are common in dry climates or during the winter months when dry, heated indoor air dehydrates the nasal membranes. Anterior nosebleeds are usually more readily controlled than posterior epistaxis.
- Posterior nosebleeds are less common. They tend to occur more often in elderly people, those with high blood pressure, and in cases of injury to the face or nose. The bleeding usually originates from an artery in the back part of the nose. These nosebleeds are more complicated and usually require admission to the hospital and management by an otolaryngologist.
Recurring nosebleeds occur for a variety of reasons:
- Allergies, infections or dryness that cause itching and lead to picking of the nose
- Vigorous nose blowing
- Inherited clotting disorders
- Medications such as anticoagulants or antiinflammatories
- Tumors, both malignant and benign
- Alcohol abuse
- Hereditary hemorrhagic telangiectasia, a disorder characterized by the presence of multiple abnormal blood vessels within the nasal lining
Significant nosebleeds should be evaluated by an ear, nose, and throat specialist. A thorough examination, including a nasal endoscopy, is often able to determine the site of the bleeding.
Two of the more common treatments include packing of the nose and cautery. When packing the nose, the otolaryngologist places special packing material or sponges within the nose to put pressure on the blood vessel. Cautery is used to coagulate the bleeding site with a radiofrequency, or electric, current or with silver nitrate, a chemical irritant applied topically. An anesthetic is placed into the nose prior to these procedures. In instances in which a deviated septum is causing excessive nosebleeds, septal surgery may be necessary. In repairing the deviated septum, any nosebleeds will be resolved as well.