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Daily Nosebleeds

Daily Nosebleeds

Dr.Jonathan M. Lee 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.

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.


Indoor Inhalant Allergies and Irritants

Indoor Inhalant Allergies and Irritants

Dr Gary Flom Gary S Flom MD FACS FAAP
American Board of Otolaryngology
Fellow American College of Surgeons
Fellow American Academy of Pediatrics
About the author: Dr Flom is a Board Certified Otolaryngologist. He practices in Metro Atlanta and is a Fellow of the American College of Surgeons as well as the American Academy of Pediatrics. His special interests include chronic sinusitis, tinnitus, vertigo and upper airway allergies.

With winter approaching, most of us will be spending more time indoors. There are many airborne irritants that may cause sneezing and nasal congestion. In addition, heating can cause a drop in humidity which can cause nasal congestion.
It seems counter intuitive, but indoor dry air caused by heating your home can cause increased nasal and sinus secretions. This is due to the mucous glands producing moisture to combat the dryness, and at times over secreting. If your house air is too dry, consider using a saline nasal spray every few hours during the day and petroleum based nasal gel at night. By applying nasal moisture, the natural response of production of excessive mucus will be curtailed.
Indoor dust mites are common and particularly like areas where there are skin cells. These areas may include any seating surfaces, mattresses, towels, etc. Anti allergy covers are available, and after washing towels, be sure they are dried well before rehanging in your bathroom. Moist towels and linens encourage mold.
If you have curtains or drapes, be sure to keep them as dust free as possible with vacuuming and possibly professional cleaning if needed.
If you have pets that are indoor/outdoor, they can bring allergens and irritants into the home. To my surprise, our dog even brought small frogs into our house! Couldn’t see them initially, as they would hitch a ride on her belly fur. Keep your pets clean and inspect their coat occasional for hitchhikers :-)
Keep your duct work free of irritants by getting duct cleanings every few years. When vacuuming, don’t forget to vacuum the vent and return covers.
Clean your clothes dryer screen every time you take clothes out. This will not only help get rid of allergens and irritants, but significantly lower the risk of a dryer fire. And don’t run your dryer at night while sleeping for the same reason.
Replace sink sponges frequently, as they are moist most of the time and can harbor mold.

Have a happy, pleasant and healthy holiday season!


What are the benefits of nasal irrigation for head colds and flu symptoms for children?

Jaime Estrada Jaime S. Estrada, RN,BSN, PHN, MSN
Credentialed School Nurse and Associate Professor at National University
About the author: As a school nurse for over 21 years, Mrs. Estrada has provided primary health care to students and parents.

With the flu season quickly approaching, an increase in health office visits and increased absenteeism will keep her busy. Many of the students suffer from nasal and sinus problems and she is constantly educating them on treatment and the need for preventive, proactive health care. The importance of attending school daily cannot be emphasized enough as chronic attendance issues have a major impact on the academic success of the students and having a runny, stuffy nose is not a reason to miss school.

Allergic rhinitis also known as nasal allergies has a huge impact on our society as this creates economic burdens from prescription costs, physician visits, and missed days of school and work. Parents must take time off from their jobs to attend to their children when in fact, missing school for nasal allergies are seldom necessary. In order to prevent absences, it is important to understand how sinuses get clogged. Our noses have two passages that filter the air we breathe. We have bones in our skulls which are air filled cavities called sinuses that drain into these passages lined with mucous membranes. When we have allergies or catch a cold, the mucous membranes become swollen and our sinuses become blocked and cannot drain. Bacteria can grow resulting in inflammation, swelling, stuffiness, pain and pressure. As a result, we develop sinus infections.
Many parents are quick to take their children to the doctor where antibiotics are seldom prescribed or push over the counter medications such as antihistamines and nasal decongestants which can cause side effects such as drowsiness, irritability or dry mouth. Parents of infants and young children with cold or allergy symptoms are encouraged to consult their pediatricians before using any of these products. The FDA recommends that young children should not take many of the commonly used cold and cough medicines. OTC cough suppressant medications are not recommended for use in infants and children as well. Research has shown that the side effects outweigh the benefits.
So how can parents reduce allergens? First, identify the triggers that cause allergies. Using an air conditioner, reducing humidity, vacuuming, and using protective mattresses and pillow covers as well as removing stuffed animals from children’s rooms will decrease symptoms. Nasal irrigation is a proactive approach in preventing allergies. Children with chronic sinus symptoms, nasal allergies, acute sinusitis and colds can benefit from this. The easy to use instructions make nasal irrigation a convenient and safe way to prevent nasal allergies. Many have experienced great success with nasal irrigation and with flu season quickly approaching, this is a more natural approach to prevention.


A gentle way to clear the day; common colds or allergies in children

Nisha R Baur Nisha R. Baur DO; FAAP
Board Certified Pediatrician

As a general pediatrician I am at the front line of care when it comes to treatment of nasal and sinus symptoms. Children typically experience 6-8 colds per year, and if in school, preschool or daycare this can almost double. Parents have a unique role in the treatment of the cough and cold in their children, to help relieve symptoms and limit side effects. In adolescents and especially young children, we try not to interrupt the delicate balance of the body by using natural means to treat symptoms. Children also pose several unique challenges when it comes to clearing the nasal passages as many have a difficult time blowing out, have smaller passages and are inclined to more frequent and longer duration symptoms related to both viral and bacterial illnesses. While many adults quickly clear a common cold, a child will have greater length and intensity of symptoms. As parents’ concern increases over their young child or infant struggling to sleep and eat well while being congested, the fatigue of sleepless nights and missed days of work compounds the worry to an even greater extent than if the parents were ill themselves.
Nasal saline and aspirators are a great way to lessen this concern and worry, as infants and children struggle to clear their own sinuses, parents can step in and help relieve symptoms, improve both sleep and eating and lessen the duration and intensity of the symptoms. Several over the counter cough and cold preparation have significant side effects or are limited in use for pediatric populations. Many of these preparations have more than one active ingredient making it difficult to dose and the dosing has not been well studied in children. Several may speed the heart rate and if they lessen congestion by thickening it, this can actually be harder for young children to manage. As parents reach into their medicine kit with NeilMed tools to help irrigate and clear the nasal and sinus passages these parents can lessen their concern as they relieve their child’s symptoms with a gentle, balanced, natural technique. Not all aspirators are created equal. Some do not generate a good suction or seal, and with delicate linings some are too hard for an infant’s nose to be used several times throughout the day. Picking a product that is gentle and effective is paramount to good use and relief of symptoms. In addition to clearing the passages, raising the head of the bed, clearing secretions just before bed, and increasing fluid taken orally to keep secretions thin and easily managed are also ways to naturally help your child through their cold in this upcoming winter season. Being on the frontline of illness, I recommend irrigation, saline rinse and nasal suction as first line on the frontline.


Is All Saline the Same?

Is All Saline the Same?

Dr.Jonathan M. Lee 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.

Although chronic sinusitis is one of the most common conditions seen by primary care physicians, I often see patients that have not received appropriate treatment. A classic scenario is an otherwise healthy middle aged patient who presents with many months of nasal congestion, postnasal drip, and thick nasal discharge. The patient has often been on multiple courses of antibiotics, nasal steroid sprays, and decongestants without significant improvement.
Chronic sinusitis is a complex disease process that is not yet fully understood. We know that is is not only an isolated problem of bacterial infection. The ability of the body to clear allergens, mucous, bacteria, and particulate matter through a process called mucociliary clearance is thought to be particularly important in managing chronic sinusitis.
Nasal saline irrigation has been demonstrated to be a safe and effective treatment for the management of chronic sinusitis, as well as allergic rhinitis. In 2007, the Cochrane Collaboration reviewed an extensive collection of research and concluded that nasal saline irrigation is beneficial for chronic sinusitis, with relatively few side effects, when used alone or in combination with other therapies.
Often primary care physicians recommend nasal saline sprays instead of irrigation, because they think that the spray is easier to use and to tolerate. When nasal saline spray has been compared to nasal saline irrigation in randomized controlled studies, however, the group that used nasal saline irrigation consistently reported less severe and less frequent symptoms such as runny nose, postnasal discharge, and need to blow the nose.
Although saline spray seems to be the same as nasal saline irrigation, I stress to patients that the key difference lies in the delivery of a large volume of liquid at low pressure. This delivery of liquid appears to greatly assist the body’s ability to clear allergens, mucous, bacteria, and other particulate matter. For this reason, I routinely instruct patients who suffer from chronic sinusitis to incorporate nasal saline irrigation into their daily regimen.


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