Dr Sonia's ENT

ENT Specialist, Head & Neck Surgeon,Bangalore
Dr Sonia Suprabha Venugopal

ENT Health Articles

Nose bleeds

Posted on June 21, 2010 at 7:07 PM

By Dr Sonia Suprabha Venugopal, ENT Specialist Bangalore

Experiencing blood coming from one’s nose or seeing it occurring in a loved one can be a scary experience. Though a frightening experience it is a fairly common condition. Our nose is a highly vascular area with a delicate inner lining .Statistically 1 in 7 people may develop a nosebleed at some point in life. Fortunately many nose bleeds are minor and it is prudent to be aware of what to do should you or a loved one experience a nose bleed. Nose bleeds or epistaxis as they are termed in medical parlance, can occur at any age, but are most common in children above 2 years and in the elderly.

Types of nose bleeds

Nosebleeds may be described as either anterior or posterior

Anterior nosebleeds (originating from the front of the nose): are more common. The bleeding usually occurs from a blood vessel on the nasal septum [ the bony- cartilaginous division between two halves of the nose]. Anterior nosebleeds are usually easy to control, either by measures that can be performed at home or by a doctor.

Posterior nosebleeds (originating from the back of the nose).are less common than anterior nosebleeds. They tend to occur more often in elderly people. The bleeding usually originates from an artery in the back part of the nose. Blood may come from the nose or trickle into the mouth and be spat out. Posterior nose bleeds are more complicated often requiring more sophisticated treatments and investigations.Depending on the cause nose bleeds may be classified as due to local or systemic factors.

Why do nosebleeds occur?

The cause of a nose bleed may be due to a factor in the nose itself or due to some underlying disease in the rest of the body having its effect on the nose or due to the effect of certain drugs.

Common causes may be classified broadly into:

Local [within nose]:

Trauma to nose- such as a

 Fall or hit on nose

 a more serious accident:see CT scan picture of patient with fractures following accident

 Picking the nose with fingers can easily injure the delicate lining of the nose and produce bleeding .This is a very common cause of nose bleeds in both children and adults alike


Foreign body in the nose

This is common in young children who may fail to tell they had inserted an object in the nose. Children may insert all sorts of objects including nuts, eraser bits, crayon pieces, chalk, parts of toys etc. In fact young children may forget about inserting the object altogether! The foreign body which remains in the nose can set up a local inflammation and resultant bleeding which can alert the parent.

Infection or inflammation in the nose or sinuses [rhinitis, sinusitis, rhinosinusitis] due to

 Viral or bacterial infections

 Allergy

 Environmental irritants

Anatomical deformities in nosee.g. septal spurs ,deviations[DNS] or abnormal blood vessels)


Drugs used in nose:

 Cocaine

 Steroid nasal sprays

Tumours of Nose, Sinuses and Nasopharynx [ region behind the nose]



Climatic factors: breathing very cold dry air in winter or very hot dry air in summer can producing drying and cracking of the lining of the nose with resultant nosebleeds.


 Low humidity contributes to drying of the nose lining and easy bleeding.

 Pressure changes such as in descent in aircraft or ascent in scuba diving.

Systemic Causes:

Hypertension[high BP or Blood pressure]- this is a common cause of epistaxis in the elderly

Infections - several viral[ HIV, Dengue, influenza, measles] ,bacterial [typhoid] and other infections[ e.g. malaria] can affect blood clotting and produce epistaxis

Blood disorders: haemophilia,leukemia,Vitamin deficiency, platelet disorders

Blood vessel diseases- vasculitis, vascular malformations such as aneurysms

Drugs affecting blood clotting-anticoagulants ,chemotherapy drugs

Snake bites

Liver, kidney diseases

Nose bleeds First Aid

How to stop a nosebleed:

  • Try to be calm
  • Sit up straight and lean the head forward. Lying down and tilting the head back can cause more blood to be swallowed.
  • Pinch the nostrils together with the thumb and index finger for 5-10 minutes. Pinching is effective in mild cases of bleeding if the soft lower parts of the sides of the nose are pinched together.
  • Avoid swallowing blood- spit it out
  • Apply ice over the nose
  • What to do after the bleeding has stopped:
  • Avoid forceful nose blowing
  • Avoid any strenuous activities, such as heavy lifting or exercise
  • Avoid very hot food and drinks
  • Visit an ENT specialist in your locality to find out the cause for the bleeding.

When to Seek Expert Medical Opinion:

It is essential to consult a doctor when there is:

  • Repeated nose bleeding over time
  • Blood in the urine or stool or sputum
  • Skin bruising
  • Excess menstrual bleeding
  • Systemic causes
  • Persistent bleeding even after first aid measures
  • Severe bleeding
  • Repeated nose bleeds within a short time
  • Dizziness or light-headedness
  • Spitting up or Vomiting blood
  • Skin rash
  • Fever

Medical Treatment

In an emergency the doctor will assess the general condition and the amount of blood loss. Immediate treatment will focus on control of the bleed and stabilizing the person. Subsequently a search for cause and definitive treatment will be instituted.

Your ENT specialist may examine the nose with a nasal speculum or endoscope to localize the site of bleed and find causative factors.


Nasal endoscopes help give an in depth view of the nose. Dr Sonia S V uses a real time video endoscope which is a high end endoscope used in daignostic and theraputic procedures.

Investigations done commonly include: blood tests, nasal endoscopy, CT scan.In certain cases an Angiography may be ordered.

Treatments may range from

Cauterization of blood vessels- a minor procedure if bleeders are in the front

Nasal packing may be required if bleeding is more. This may be in the form of a ribbon gauze, balloon or sponge pack.

Endoscopic bleeder control

Arterial ligation or embolisation

Specific treatments vary depending on the individual situation and include treatment of sinusitis or allergies, correction of anatomical septal deviations or spurs.


Sponge for nasal packing


Balloon for nasal packing


• Avoid blowing the nose too vigorously

• Avoid nose picking

• Vaseline, antibiotic ointment, or a saline nasal spray may be used to keep the nasal passages moist- your ENT specialist will advise on proper usage techniques of these.

• If the nosebleed is related to another medical condition, such as a chronic sinus or allergy condition or hypertension or liver disease, follow your doctor’s instructions to keep that problem under control.

• Avoid injudicious steroid nasal spray usage : use only in the method instructed by your ENT specialist and only for the recommended duration. See article on how to use nasal sprays correctly

• A person on anticoagulant therapy or chemotherapy requires periodic blood investigations to detect blood dyscrasias.

Dr Sonia Suprabha Venugopal


Consultant ENT & Head & Neck Surgery

Location: BANGALORE:Sadashivnagar,Sahakaranagar,RT Nagar,Hebbal




ENT Specialist Bangalore

Categories: Nose and Sinuses, Paediatric ENT, Allergy