What is Epistaxis?
Epistaxis is the medical term for a nosebleed.

Are nose bleeds serious?
Contrary to popular belief, nose bleeds are not usually serious. The typical movie scenario where someone has a nose bleed and the outcome is a serious underlying disease such as a tumour is really misleading.

What are the causes of nosebleeds?
The most common reason for nosebleeds are related to local causes in the nose. Any cause of nasal inflammation can predispose one to nosebleeds. Underlying factors are allergy, dryness, hot weather, flu or cold, irritation for any reason. The final trigger is minor trauma such as picking, sneezing or rubbing.

Are there any underlying risks?
Yes. Most of these are the common medical problems. Hypertension, diabetes, liver problems and kidney problems. Other medical problems such as blood cancers (leukaemia or lymphoma) or a hereditary lack of clotting factors are rare.

During which seasons do bleeding occur mostly?
There is no rule as it depends on the cause. A dry nose and infections is the major risk in winter. Dilated blood vessels, due to the heat, is the major risk in summer. Allergy is the risk in spring.

Do any medications cause bleeding?
Yes. Medications that affect platelet (a cell in the blood that is needed to form a clot) function and some that affect the clotting factors (proteins in blood that help forms clots) can cause bleeding. Examples of these medications are aspirin containing tablets, heparin and warfarin. Some heart medication contain aspirin like ingredients. It is also important to know that some homeopathic medications are associated with an increased risk of bleeding. Ginkgo biloba and arnica are examples. (It is important to note that this is the reason all the above medications should be avoided prior to surgery. Please inform your surgeon if you are on these medications.)

How do you stop a nosebleed?
Sit with the head slightly forward. Pinch the soft part of the nose firmly for 7-10min. Breath through the mouth and suck some crushed ice. Spit out the blood that comes out the back of the nose into the mouth. Once you release the pressure, DO NOT blow your nose or wipe to “check” if the bleeding has stopped. This will just restart the bleeding. Leave the clot that has formed alone, even if you have a blocked nose. The clot will fall out once the clot has stabilized.
Ice behind the neck does very little. Ice on the forehead or bridge of the nose is also not that helpful.

When do you see a doctor?
If the bleeding does not stop after the above is done properly, please see you GP or ENT. If a person has a major underlying medical problem or is on wafarin, aspirin or similar medications, go to a casualty urgently. Do the above and do not self treat. If the nose bleeds recurrently, see your ENT.

What is the next step?
After recurrent bleeding, the ENT will cauterize or burn the bleeding area.

What do we expect at this examination?
The ENT will clean out the nose and apply local anaesthetic. A thorough check-up inside the nose is mandatory to make sure that there is no sinister cause. Cauterization of the causative blood vessels is done using a chemical or electro-cautery method.

What happens if this fails?
If cautery fails or if the bleeding is severe, the nose will have to be packed temporarily using nasal tampons or gauze to tamponade the bleeding. The underlying risks are then investigated and treated. Packs are usually withdrawn once stabilized. If this fails, an examination under anaesthesia is performed to look for the source.

Ear,Nose and Throat Specialists