What causes bloody noses

Nosebleeds

Competence center for ENT (ear, nose and throat medicine) informs: Nosebleeds

Definition of epistaxis

ENT specialists differentiate between:

  • Bleeding in the front of the nose (anterior epistaxis)
  • Bleeding from the posterior lateral wall of the nose (posterior epistaxis)

The nasal mucous membrane is well supplied with blood and is traversed by many fine, delicate vessels. They can be injured by blowing their nose heavily, a fingernail in or a blow on the nose, and they can tear easily with colds and dry nasal mucous membranes.

Most of the bleeding (around 90%) occurs in the front part of the nose, called the Kiesselbachi locus.

If there is suddenly bleeding from one nostril or both nostrils, it is uncomfortable for those affected, but mostly harmless.

However, if there is bleeding in the upper part of the nose, the blood does not run out of the front of the nose, but down the back of the throat. You should see an ENT doctor immediately.

Even if the nosebleed persists after 20 minutes or if it keeps coming back, you should consult an ENT specialist to clarify the cause.

The nosebleed can also hide a serious illness. In addition, high blood loss can be life-threatening.

Around every second adult has had a nosebleed at some point. It can also occur suddenly in children.

Synonyms and related terms

Synonyms: epistaxis
English: nosebleed, epistaxis

overview

Nosebleeds occur in all age groups. However, children suffer from it more often than adults.

They often injure the vessels in the nose with a foreign body, e.g. pearls, marbles, buttons or nuts, which they put in their nose. Parents should then immediately consult an ENT doctor, who can usually remove the foreign body quickly under local anesthesia.

In adults, drilling the nose or blowing the nose in particular leads to injuries to the nasal mucosa, causing it to bleed.

Another condition can be hiding behind a nosebleed. For example, high blood pressure, bleeding disorders, infections with fever, an allergic runny nose or kidney disease.

Women are more likely to have nosebleeds during pregnancy.

If you suffer from it all the time and can't pinpoint the cause, make an appointment with your ENT doctor.

In most cases, nosebleeds will stop on their own. However, if there is very heavy bleeding from the nose, it can lead to dangerous blood loss. An ENT doctor should then be consulted immediately.

Causes of the nosebleed

The ENT specialist identifies many different causes of nosebleeds:

  • Strong blowing or piercing in the nose
  • Dry nasal mucosa due to overheated rooms in winter and air conditioning in summer
  • Allergies, e.g. hay fever
  • Nasal polyps
  • Severely damaged nasal mucous membranes
  • Hit or fall on the nose
  • Injury to the vessels from a foreign body in the nose
  • Collections of pus (abscess)
  • Other diseases, especially kidney disease, high blood pressure (hypertension), arteriosclerosis, flu, measles, hemophilia (hemophilia), leukemia
  • Tumors
  • Use of drugs that prevent blood from clotting in the body
  • Regular consumption of nicotine and alcohol

What to do yourself if you have a nosebleed

ENT specialists recommend the following measures if you have a nosebleed:

  • Sit up straight or keep your head high.
  • Bend your head forward, prop your forehead so that the blood can flow out of the front of your nose.
  • Breathe in and out calmly through your mouth.
  • Use your thumb and forefinger to pinch your nostrils together for a few minutes - provided the nose is not swollen and the nasal bone is not broken.
  • Use an ice pack or cold, damp washcloth to cool your nose.
  • Under no circumstances should you tilt your head as the blood will run down your throat and down your esophagus to your stomach.

If the bleeding cannot be stopped, you must see an ENT doctor immediately.

Help from the specialist

Depending on the specificity of the symptoms, further detailed diagnostics can be carried out by various specialists based on a discussion with your doctor. These include:

What to expect from your ENT doctor?

Before your ENT doctor begins an examination, there will be an introductory discussion (anamnesis) about your current symptoms. As part of this, he will also ask you about previous complaints and any existing illnesses.

You can expect the following questions:

  • How long have the symptoms existed?
  • Can you carry out a precise characterization and, if necessary, localization?
  • Have there been any changes in the course of the symptoms?
  • Do you suffer from additional symptoms such as shortness of breath, chest pain, dizziness?
  • Have you ever suffered from it and did these symptoms occur in a family way?
  • Do you currently have previous illnesses or hereditary diseases and are these treated?
  • Are you currently taking any medication?
  • Are you aware of any allergies?
  • Do you suffer from stressful conditions in everyday life?

What medications do you take regularly?

Your ENT specialist will need an overview of the medicines you take regularly. Before you go to your doctor, make an overview of the medication you are taking in a table. You can find a template for the overview here.

Examinations (diagnostics) by the ENT doctor

Based on the symptom characteristics recorded in the previous anamnesis and the current state of health, the ENT specialist can now apply the following diagnostics:

  • Control of blood pressure
  • Heart rate measurement
  • Nasoscopy (rhinoscopy)
  • Blood test
  • Ultrasound (sonography)
  • Computed tomography (CT)
  • Magnetic resonance imaging (MRI)

If the ENT doctor cannot identify any local causes, he will consult other specialist colleagues in order to identify possible organic triggers for the nosebleed. If a tumor is suspected, computed tomography or magnetic resonance imaging is performed.

Treatments (therapy)

The ENT specialist first stops the acute nosebleed. If the bleeding is localized in the front area of ​​the nose, the blood vessels are obliterated with acid etching or electrocoagulation or laser coagulation.

Then the interior of the nose is treated with an ointment by the ENT doctor.

If this does not stop the nosebleed, he puts a tamponade on both sides to put sufficient pressure on the blood vessels. An alternative are inflatable balloon catheters made of silicone.

Once the ENT doctor has identified the source of the bleeding in the back of the nose, he will usually place a back tamponade under anesthesia (Bellocq tamponade).

If the bleeding is very heavy, the vessels can be closed (embolized) with a clip.

Persistent nosebleeds sometimes require surgical intervention.

If the nosebleed is caused by another disease, it must be treated. The ENT doctor will then work with colleagues from other medical specialties on the treatment (therapy).

Prevention (prophylaxis, prevention)

ENT specialists point out that a healthy nose cleans itself. You should therefore not pick your nose or blow your nose excessively.

If your nasal mucosa is very dry and this is causing the nosebleed, special nasal ointments or nasal oils can help to keep the nasal mucosa moist and supple.

In winter, you can use humidifiers and large potted plants to humidify the dry room air in your home and thus protect your nasal mucous membrane.

Drink enough. This also helps to keep your nasal mucosa moist. Inhale regularly or rinse the nasal mucosa with a special saline solution. Prevent with a vitamin-rich diet. Especially with vitamin C, which is particularly found in citrus fruits. Vitamin K is necessary for blood clotting and

occurs mainly in broccoli, cabbage and spinach.

forecast

Nosebleeds are usually uncomfortable, but not dangerous. Most of the time it stops on its own. In rare cases, this is due to another serious illness.

© CHHG