Nosebleeds: When Can It Get Serious?

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Epistaxis or what we commonly refer to as nosebleeds occur when there is a loss of blood from the tissues lining the nasal cavity. Nosebleeds are quite common, and often not of serious concern. Nosebleeds among children are quite common and not all nosebleeds need medical intervention. The central position of the nose makes it an easy target for injury.

Knowing the cause is helpful to understand if it is necessary to visit the ENT doctor. The ENT Clinic practices evidence-based medicine and the experienced Singapore ENT physicians in the clinic like Dr. Jeeve, Dr. Annabelle, or Dr. Hobbs will take a caring and patient-centric approach to resolving the issue.

What are the causes of nosebleeds?

There can be many causes behind a nosebleed. While most of the cases are minor, there could also be instances when it needs immediate intervention. Some of the common causes of nosebleeds include:

  • Trauma: A nose bleed can happen if there is a fracture to the nose or a head injury. Nosebleeds due to trauma should not be ignored. This is quite common in children where injury may be caused by hitting on objects or insertion of objects to the nose. Such kinds of nose bleeds need immediate intervention by an experienced ENT specialist.
  • Dry Air: During dry weather outdoors or indoors caused by a heating system, it can cause the body to dry. The nasal cavity too gets affected and could become irritated. This causes the nasal membranes to dry out. The dryness in the nose causes itchiness which makes one pick their nose. This can lead to a bleed. During winters nosebleeds are quite common, this is because of the dry weather. Repeated nose picking and blowing of the nose can easily cause nasal bleeds.

Some of the other reasons why nosebleeds can occur include:

  • Respiratory Tract Infections: When one has a respiratory tract infection like a cold, then it causes an individual to blow their nose frequently. Blowing the nose with force too can cause pressure to build. This pressure can cause the superficial blood vessels to rupture leading to a nose bleed.
  • Nose Picking: There are reasons why an individual has a higher frequency to pick their noses. This includes ENT conditions such as hay fever and allergies. These conditions cause the nose to itch. Due to this  an individual may consciously or unconsciously pick their nose frequently.
  • Hemophilia: Recurring nosebleeds might occur in individuals who have clotting disorders like hemophilia and hemorrhagic telangiectasia.
  • Medications: Certain medications can make nosebleeds more frequent or difficult to stop. This includes anticoagulants such as warfarin, aspirin and clopidogrel. Some of the other topical medications and nasal sprays include anti-histamines, corticosteroids and nasal sprays which can cause nasal irritation. It could also include regular dietary supplements such as ginger, garlic and  ginseng.
  • Structural deformities: Individuals who have septal deviations or other functional deformities can have frequent nosebleeds. Also, the presence of tumors in the nasal cavity, whether it is a malignant one or a benign one,  can lead to a nosebleed.
  • Chronic disease: Underlying diseases such as kidney disease or liver disease could lower one’s ability of blood clotting. Other conditions include congestive heart failure and hypertension resulting in nosebleeds.
  • High altitudes: Traveling to high altitudes reduces the level of oxygen and increases the dryness of the air. This often leads to nosebleeds.

Are all nosebleeds serious?

The seriousness of the nosebleed depends on the root cause of the problem. Nose bleeds caused due to a respiratory tract infection can be considered minor, but bleeding due to a tumour, or a chronic disease or head injury must not be overlooked. Hence the importance of an otolaryngologist consultation when it is necessary is a must.

When to seek medical help?

An individual must seek medical help if the nose bleeding continues even after 20 minutes, or if bleeding is the result or a head injury or if the nasal bones feel broken.

In addition, individuals who face recurrent nasal bleeds must be evaluated closely. Some of the other reasons to visit an emergency room include loss of a large amount of blood, difficulty in breathing, vomiting and fractures to the head.

What should I expect at the medical practice?

The physician will conduct a medical examination and take a medical history to understand the duration of bleeding, amount of  blood loss and if the bleeding involves one or both nostrils. The ENT physician would also want to know if you are taking any blood thinning medications, or you have any chronic diseases.  These questions are asked to determine the source of the bleed. A light endoscope may also be used to examine the nasal interior.

If the cause cannot be established with an endoscope, then X-rays, CT scans and blood tests may be done. This helps to identify if there is any bleeding disorder or a tumour.

What are the treatment methods for nosebleeds?

The exact treatment method depends on the cause. Some of the common treatment methods include:

Nasal packing: This is when a nasal sponge is left to create pressure at the site of bleed. It’s left for a day or two and removed by medical staff. This stops the bleed.

Cauterization: This is the application of silver nitrate or heat energy to seal the blood vessels which is causing bleeding.

Terminating certain medications: It may be important to stop high doses of blood thinners and anti-hypertensive medications.

Repair of a deviated septum: Surgical repair of a deviated septum if that is the cause of the bleed.

Can nasal bleeds be prevented?

Yes, certain steps may be useful to prevent nasal bleeds and these include:

  •  Lifestyle modifications: Use of drugs and alcohol must be minimized.
  •  Nasal irrigation: Keeping the nasal cavity hydrated with a saline nasal spray.
  •  Hydration in the room: Use of a humidifier to prevent drying.
  • Avoiding forceful nose blowing
  • Limiting intake of medications: Dose adjusting of medicines like ibuprofen and aspirin.
  • Avoiding trauma: Avoiding accidents which may lead to trauma.

The ENT Clinic Singapore has a specialised adult and paediatric ENT practice. It is among the best places to visit for a nose bleed in Singapore as it has received multiple awards and praise from patients. Conveniently located in Gleneagles Hospital and Mt. Elizabeth Novena Center, this state-of-the-art ENT facility should be a primary choice for any ENT malady.