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A nosebleed can be a very frightening experience at any time. But if one happens because of either injury or accident -- as unpleasant and, perhaps, painful as that may be -- it's easier to understand and accept than one that occurs for some unexpected, unexplained reason.
Even minor ones that can develop occasionally, either because of, say, prolonged exposure to dry heat in the winter from a home-heating system, or a nosebleed that might be related to a cold and its related medications, are explainable.
Real cause for concern arises when something triggers nosebleeds out of the blue -- often and for no apparent reason. If this is the case, then, medical help is necessary.
"The most common cause of nosebleeds is dryness in the lining of the nose -- something that happens naturally as we age. And as we age, the frequency of nosebleeds goes up," explained Avraham Hampel, M.D., of Ear, Nose and Throat Associates, Inc. in Elkins Park.
"Nosebleeds," he continued, "are very common in winter, for example, because of heating systems, when there is nearly zero humidity in the air inside a home, so a humidifier is a good idea. And in recent years, another cause of nosebleeds is the increased use of blood thinners, such as Plavix, cumidin and aspirin."
Most nosebleeds aren't serious, he continued, with people able to control 90 percent of them at home. Those that are chronic and occur at the posterior or back of the nose can be signs of a more serious condition, such as a malignant or benign tumor, or polyp. Smokers also develop tumors in the sinuses, said Hampel.
Frequent nosebleeds shouldn't be ignored because they point to "some systemic problem and should be treated professionally," he remarked, "since they can be a warning or symptom of some major medical problem."
Something Else Involved
Posterior nosebleeds are much more common above the age of 40, he reported. When tumors, which are not a common occurrence, are suspected, the first step is to have a CT scan of the back of the nose.
"Tumors of the nasal cavity and the nasal pharynx can hide for a long time. In addition to triggering nosebleeds, they also can cause hearing loss because of fluid in the middle ear," explained the doctor.
A chronic condition is ulcers on the septum, he added; these can cause bleeding and tend to come back, and may be treated with an antibiotic ointment.
"The key to the examination is to localize the bleeding through pressure, cauterization with the chemical silver nitrate to burn the bleeding site, and packing the nose, usually for from 24 to 48 hours, and sometimes longer. When nosebleeds reoccur often, other measures, including surgery, may be necessary," said the otolaryngologist.
Chronic nosebleeds can be signs of a number of serious illnesses, he acknowledged. "There are a whole group of diseases and conditions that affect the septum and other parts of the nose, causing nosebleeds, such as a nasal-septum perforation, in which the cartilage will sluff off from the septum, with bleeding coming from the edges."
Other causes are infectious diseases, such as typhoid fever, commented Hampel, the use of a steroid-based nasal inhaler, a deviated nasal septum that causes air to continually strike and dry out the convex side of the nasal passages, and exposure to toxic chemicals, such as mercury -- "rare, but it can happen."
More causes are allergies that bring congestion and require the use of medications, along with self-medicating with herbal preparations, which can interfere with clotting and coagulation.
"If you're having nosebleeds, tell your doctor about any herbals you may be taking," Hampel advised.
Simply picking the nose, having a rhinoplasty -- commonly referred to as a "nose job" -- and engaging in any type of sniffing drugs (an obviously dangerous activity that destroys the septum) also cause nosebleeds, noted the doctor.
"Nosebleeds can be very tricky to control, especially the chronic ones, so we give patients a brochure that outlines what they should do. One day, recently, we had 13 cases of nosebleeds in the office, most of which we were able to stop without sending anyone to the hospital.
"And, by the way, it's a myth that someone will not get a stroke if nosebleeds happen," he concluded.
Elizabeth Datner, M.D., medical director for the department of emergency medicine at the Hospital of the University of Pennsylvania, went on to elaborate about nosebleeds from her perspective as an emergency-room physician.
"The vast majority of nosebleeds that we see are related to trauma, usually local trauma to that area of the face is the most common type, but there are other causes of nosebleeds, too, including infections and allergies that dry out the mucosa," she explained. "It's thought that high blood pressure can cause a nosebleed, but that hasn't been proven.
"Nosebleeds in the anterior portion of the nose -- the front -- are easier to control than those in the posterior of the airways, which are harder to get to. You'll see people pinch their noses to stop the flow of blood, but depending on the type of nosebleed, compression works best," she advised.
Carrying her explanation a step further, Datner said that people shouldn't lie down when having a nosebleed, as it isn't healthy to continually swallow blood.
"It's much better to be sitting up and compressing the nose for a true five minutes. Also, a cool cloth or ice on the forehead can work to stop a nosebleed," she said, "while Afrin, a drug that constricts blood vessels, works sometimes, but if there is high blood pressure you have to be careful."
There are some people who get nosebleeds spontaneously, she added, because their blood vessels are superficial due to growths in the nasal passages.
Usually, it's some underlying serious problem that's the cause. An aneurysm, for example, can cause a nosebleed, she said, and occasionally, surgery is required to repair the artery causing the bleeding.
She added that packing the nose is an effective control because it increases pressure on blood vessels to stop the flow.
"Theoretically," she conceded, "someone could bleed to death because of a nosebleed, but that is not at all a common occurrence."