Nosebleeds (Epistaxis)

Epistaxis, better known as nosebleeds, may be more common than you realized. It is estimated that as many as 60% of the population have at least one nosebleed in their lifetime and up to 6% of those people require medical treatment.

Anterior nosebleeding commonly occurs in children and is rarely a cause for concern. Typical causes include dry climate, colds, allergies, or mild abrasions. These nosebleeds are usually relieved by pinching the nostrils or lightly packing the nose. 1 Posterior nosebleeds, however, may sometimes occur in adults, may be a symptom of a significant medical problem, and can cause life-threatening blood loss if left uncontrolled.

Special nasal packs (Epistats) may be placed by an ENT or emergency medicine physician.

Initial treatment for posterior epistaxis may include application of pressure and the use of nasal decongestants, which cause the blood vessels to constrict, minimizing the bleeding. If these methods are unsuccessful, special nasal packs (Epistats) may be placed by an ENT or emergency medicine physician. If bleeding is severe, a blood transfusion may also be necessary. Further treatment may involve a procedure called cauterization. This entails minor surgery to identify the the bleeding site and burning the bleeding site by applying heat, thus coagulating the nasal tissues to induce healing.

When all the foregoing measures have failed or the ENT surgeon cannot readily reach the bleeding site, a person may require endovascular embolization. This procedure is designed to block off the bleeding vessels from the inside. A catheter or tube is inserted into the common femoral artery, usually at the crease in the leg at the underpant line. With a little local anesthetic at the site where the catheter is inserted, this procedure can be performed painlessly. The catheter is then guided to the vessels deep in the face which lead to the back of the nasal cavity and the point of the bleeding. Embolic material, usually a temporary blocking agent called PVA (surgical sponge particles) are injected into the bleeding vessels which causes those vessels to clot and heal. This blockage is only temporary, so that the vessels completely return to normal within several months after the nasal tissues have healed. Patients must undergo treatment for the underlying cause of their hemorrhage, most commonly the cause is uncontrolled or unrecognized high blood pressure (hypertension).

Following the procedure, a doctor may recommend simple anti-inflammatory medications for a few days to control pain. This procedure is associated with a very low risk of complication, and a success rate of 80%-90% measured by the absence of future bleeding. Embolization may be performed as an outpatient procedure, and patients can generally resume normal activities within several days.