San Francisco Ear Nose Throat Specialist

Nosebleed (epistaxis) is a common problem and nuisance for patients. In minor cases it may be stopped spontaneously within minutes; however, it can also lead to major bleeding episodes requiring immediate medical attention.

Risk Factors

Children: Nose picking/ trauma

Adults: Chemical and environmental irritants (i.e. tobacco smoke, chemicals), and cocaine abuse, dry weather

Elderly: High blood pressure, those using blood thinners like Coumadin, Plavix, and aspirin.

Treatment

Most nosebleeds occur within the front part of the nose and can be controlled and prevented at home. If you have an active nosebleed or repeat bleeding, try this initially:

Four sprays to both nostrils of Neo-Synephrine (phenylephrine) or Afrin (oxymetazoline) to constrict the blood vessels. These are available over the counter.
Firmly pinch the lower base of the nose (as if plugging your nose) for 15 minutes.
Repeat the above once again if persistent. If unsuccessful, seek medical attention while still firmly pinching the nose.

Further medical treatment may require cautery and nasal packing. Packing may be resorbable or required removal in a few days. Antibiotics are given to prevent infection from the packing. Underlying illnesses like high blood pressure or bleeding disorders should be controlled. Frequently a hospital admission is needed for safe control and treatment of major nosebleeds. Embolization of major nasal vessels may be required if the above measures fail.

Prevention

Prevention of future nosebleeds requires moisturizing the nose with saline rinse and humidifier, and controlling the underlying risk factors. The following may be recommended by your physician:

Apply Bactroban, Vaseline, or antibiotic ointment (i.e. Neosporin) to both sides of the nose twice daily for 10 days, then as needed thereafter.
Salt water, Alkalol or Pretz nasal sprays: 2 sprays each nostril 5-10 times daily for 10 days, then as needed thereafter. These are purchased over the counter.
Do not blow your nose for 10 days. Gentle sniffing is allowed
Do not strain or lift greater than 15 lbs for 2 weeks. This may increase the blood pressure in the face and nose to cause more bleeding.
See your primary care physician if control of blood pressure, bleeding problems or blood thinners are required.
Quit smoking.
If you require oxygen at home, avoid the nasal route for 2 weeks. Redirect the oxygen flow to the mouth to prevent nasal dryness.