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Epistaxis or Nosebleed

Epistaxis or Nosebleed

Dr.Jackson Ryan Ryan S. Jackson, MD
Otolaryngology – Head and Neck Surgery

Epistaxis, commonly called a nosebleed, is a common complaint of many people. Nosebleeds are typically minor and rarely become life threatening. Despite rarely being life threatening, epistaxis can create significant concern among patients. Patients should seek immediate medical attention if the bleeding is severe or if it does not subside with routine measures (manual pressure along the anterior nose and/or topical decongestants such as oxymetazoline).

Epistaxis has many causes. Common causes include high blood pressure, trauma (digital or blunt trauma to the nose), inflammatory diseases, septal abnormalities, vascular abnormalities and rarely tumors. Under many circumstances, bleeding occurs when the lining of the nose (mucosa) becomes dry, allowing blood vessels to become exposed and break along the surface of the mucosa.

Besides controlling any underlying condition contributing to epistaxis, nasal saline may be used to help prevent recurrent epistaxis. If bleeding is secondary to excessive dryness, nasal saline as a spray, irrigation, or gel can be useful to moisturize the mucosa of the nasal cavities. The moisture decreases the friability and cracking of the mucosa, thus decreasing the risk of rupturing fragile blood vessels under the surface of the mucosa. Nasal saline can be used safely in adults and children multiple times per day without adverse side effects. Petrolatum ointment may also be placed on the inside of the nose with a cotton tipped applicator for a couple of weeks to help moisturize the mucosa.

In summary, dryness of the nasal mucosa may lead to epistaxis. Moisturizing the nasal mucosa with nasal saline, either as a spray, irrigation, or gel, may help prevent future nosebleeds.


Principles of Nasal Irrigation

While some amount of mucus production from the nasal and sinus lining is normal, allergies and sinus infections can cause excessive mucus production. This excessive mucus production causes nasal and sinus symptoms such as a runny and stuffy nose or post nasal drip. The key to symptom relief is to physically wash away this excess mucus and allergens such as grass and tree pollen, dust particles, pollutants and bacteria from the nasal passages. The rinsing will reduce inflammation of the mucosa membrane, allowing you to breathe more normally.

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