The nasal mucosa is heavily supplied with blood and is traversed by many fine, delicate vessels. They can be injured by strong blowing, a fingernail in or a blow on the nose, and can tear easily in colds and dry nasal mucosa.
Most bleeding (about 90%) occurs in the front part of the nose, the so-called locus Kiesselbachi.
If it bleeds suddenly from one nostril or from both nostrils, it is unpleasant for the affected person, but usually harmless.
However, if it bleeds in the upper part of the nose, the blood does not run out of the front of the nose but down the back of the throat. You should consult an ENT specialist immediately.
Also, if the nosebleed continues after 20 minutes or if it keeps recurring, consult an ENT specialist to have the cause clarified.
Behind the nosebleed can also hide a serious disease. In addition, high blood loss can become life-threatening.
About every second adult has had a nosebleed at least once. It can also appear suddenly in children.
Synonyms and related terms
Synonyms: epistaxis English: nosebleed, epistaxis
Nosebleeds occur in all age groups. However, children suffer from it more often than adults.
They often injure the vessels in the nose by a foreign body, z.B. beads, marbles, buttons or nuts to put them in the nose. Parents should then immediately consult an ENT doctor, who can usually quickly remove the foreign body under local anesthesia.
In adults, especially picking the nose or blowing the nose violently leads to injuries of the nasal mucosa so that it bleeds.
Nosebleeds can also hide another disease. Such as high blood prere, blood clotting disorders, infections with fever, an allergic rhinitis or kidney disease.
In women, nosebleeds occur more frequently during pregnancy.
If you suffer from it all the time and cannot find the cause, you should make an appointment with your ENT specialist.
In most cases, nosebleeds stop on their own. However, if the bleeding from the nose is very severe, you may experience dangerous blood loss. An ENT physician must then be consulted immediately.
Causes of nosebleeds
The ENT specialist identifies many different causes of nosebleeds:
– Blow vigorously or pick your nose – Dry nasal mucosa due to overheated rooms in winter and air conditioning in summer – Allergies, z.B. Hay fever – Nasal polyps – Severely damaged nasal mucous membranes – Blow or fall on the nose – Injury to the vessels caused by a foreign body in the nose – Pus accumulation (abscess) – Other diseases, especially kidney disease, high blood prere (hypertension), arteriosclerosis, influenza, measles, hemophilia (hemophilia), leukemia – Tumors – Taking medications that inhibit blood clotting in the body – Regular consumption of nicotine and alcohol
What you can do yourself in case of nosebleeds
ENT specialists advise the following measures in case of nosebleeds:
– Sit up straight or put your head up high. – Bend your head forward, supporting your forehead to allow blood to flow out the front of your nose. – Breathe in and out calmly through your mouth. – Squeeze the nostrils with your thumb and index finger for a few minutes – if the nose is not swollen and the nasal bone is not broken. – Cool your nose with an ice pack or a cold, damp washcloth. – Do not rest your head on the back of your neck, otherwise the blood will run down the throat and through the esophagus into the stomach.
If the bleeding cannot be stopped, you must see an ENT doctor immediately.
Help from the specialist
Depending on the specificity of the symptomatology, further detailed diagnostics can be made by various specialists based on a discussion with your doctor. These include:
What to expect from your ENT specialist?
Before your ENT doctor starts an examination, there will be an introductory conversation (anamnesis) about your current complaints. In this context, he will also ask you about past complaints and any existing diseases.
You can expect the following questions:
– Since when do the symptoms exist? Can you give an exact characterization. Localize if necessary? – Have there been any changes in the course of the symptoms? – Are you experiencing additional symptoms, such as shortness of breath, chest pain, dizziness? Have you ever suffered from. If these signs run in your family? – Are there any current pre-existing conditions or hereditary diseases and are these being treated? – Take current medication? – Are you aware of any allergies? – Do you suffer from stressful conditions in everyday life?
What medications do you take regularly?
Your ENT specialist needs an overview of the medicines you regularly take. Even before you see your ENT doctor, compile an overview of the medications you take in a chart. You can find a template for the overview here.
Examinations (diagnostics) by the ENT specialist
Based on the symptom characteristics collected in the previous anamnesis and the current condition, the ENT specialist can now apply the following diagnostics:
– Control of blood prere – pulse measurement – nasal endoscopy (rhinoscopy) – blood test – ultrasound (sonography) – computer tomography (CT) – magnetic resonance imaging (MRI)
If the ENT physician cannot identify any local causes, he or she will consult other specialists in order to identify possible organic triggers of the nosebleeds. If tumor disease is suspected, a computed tomography or magnetic resonance imaging scan is performed.
The ENT specialist first stops the acute nosebleed. If the bleeding is localized in the front part of the nose, the blood vessels are sclerosed with acid etching or electro- or laser coagulation.
Afterwards, the interior of the nose is treated by the ENT doctor with an ointment.
If this does not stop the nosebleed, he applies a tamponade on both sides to exert sufficient prere on the blood vessels. An alternative are inflatable balloon catheters made of silicone.
Once the ENT specialist has identified the source of the bleeding in the back of the nose, he or she will usually place a posterior tamponade under anesthesia (Bellocq tamponade).
If the bleeding is very severe, the vessels can be closed with a clip (embolized).
Constantly recurring nosebleeds sometimes need to be treated by surgery.
If the nosebleed is caused by another disease, this must be treated. The ENT specialist will then collaborate with colleagues from other medical specialties in the treatment (therapy).
Prevention (prophylaxis, prevention)
ENT specialists point out that a healthy nose cleans itself. Therefore you should not pick your nose. Refrain from excessive blowing.
If your nasal mucosa is very dry and the nosebleeds are caused by this, special nasal ointments or nasal oils help to keep the nasal mucosa moist and supple.
In winter, you can humidify the dry air in your home by using humidifiers and large potted plants to protect your nasal mucosa.
Drink enough. This is another way to help keep your nasal mucosa moist. Inhale regularly or rinse the nasal mucosa with a special saline solution. Prevent with a diet rich in vitamins. Above all, with vitamin C, which is contained especially in citrus fruits. Vitamin K is necessary for blood clotting and
is found mainly in broccoli, cabbage and spinach.
Nosebleeds are usually unpleasant, but harmless. It usually stops again on its own. In rare cases there is another serious disease behind it.