ear, nose, and throat disorders
Nosebleeds
Treatment of Nosebleeds
Doctors initially treat all nosebleeds as they would treat an anterior nosebleed. The few people who have lost a large amount of blood are given fluids by vein (intravenously) and rarely blood transfusions. Any known or identified bleeding disorder is treated. Bleeding from blood vessels in the front part of the nose usually can be controlled at home by pinching the nostrils together for 10 minutes while the person sits upright. People should not pinch over the bony upper part of the nose. It is important to hold the nose with a firm pinch and not let go even once during the 10 minutes. Other at-home techniques, such as ice packs to the nose, wads of tissue paper in the nostrils, and placing the head in various positions, are not effective. If the pinch technique does not stop the bleeding, it can be repeated once for another 10 minutes. If the bleeding does not stop after the second 10 minutes, the person should see a doctor. The doctor typically places several pieces of cotton in the bleeding nostril. The cotton is saturated with a numbing medication (such aslidocaine) and a medication that causes blood vessels in the nose to close (such asphenylephrine). Then the nose is pinched for 10 minutes or so and the cotton is removed. For minor bleeds, often nothing more is done. For more severe or recurring bleeding, sometimes the doctor seals (cauterizes) the bleeding source with a chemical,silver nitrate, or an electrical current (electrocautery). Alternatively, doctors sometimes place a special foam sponge (nasal tampon) in the nostril that is bleeding. The sponge swells to stop the bleeding. The gauze or sponge is removed after 2 to 4 days. If these methods are ineffective, various commercial nasal balloons can be used to compress bleeding sites. Sometimes the doctor has to pack the entire nasal cavity on one side with a long strip of gauze. However, this procedure can be painful. Nasal packing is usually removed after 3 days. Bleeding from blood vessels in the back part of the nose is very difficult to stop and can be life threatening. For this type of nosebleed, the pinch technique does not stop the bleeding. Pinching simply makes the blood run down the throat instead of out the nose. For a posterior nosebleed, doctors may place a specially shaped balloon in the nose and inflate it to compress the bleeding site. However, this and other types of posterior nasal packing are very uncomfortable and interfere with the person’s breathing. Doctors usually give people sedatives by vein before inserting this kind of balloon and packing. Also, people who have had this type of packing are admitted to the hospital and given oxygen and antibiotics to prevent an infection of the sinuses or the middle ear. The packing remains in place for 4 to 5 days. This procedure causes discomfort, but the discomfort can be relieved with treatments. If the balloon or packing does not work, doctors need to directly close the bleeding vessel. Doctors typically do a surgical procedure in which an endoscope is used to examine the interior of the sinus. The endoscope enables the doctor to reach and close off (typically with a clip) the larger artery that feeds the bleeding vessel. Occasionally, doctors use x-ray techniques to pass a small catheter through the person’s blood vessels to the bleeding site and inject material to block the bleeding vessel (embolization). 