Nose bleeds is a very common ENT problem that causes people to visit the emergency room. Nose picking is easily the commonest cause of nose bleeds in children. But it happens in the case of adults too. What happens when you are fifty years old and have a use bleed when you have never picked your nose?
You must get checked by a professional.
Can nosebleeds be caused by high blood pressure
Yes, that is common in older hypertensive adults and often causes more of posterior epistaxis, where you have blood trickling down your throat like a postnasal drip. Nose bleeds can be due to a local cause or something more generalized like hypertension. It’s often a warning in case undiagnosed high blood pressure and acts to prevent other cardiovascular problems like heart attacks, strokes.
In Dengue, leukemia and any condition which causes poor clotting, bleeding can occur.
Nose bleeds can occur frequently
Local causes like sinusitis, septal hematoma, nasopharyngeal angiofibroma and other tumors of nose and sinuses can present with nose bleeds. A chronic post nasal drip in a hypertensive, diabetic fifty-year-old needs a full checkup.
The important thing to remember is early diagnosis and management are best for the management of nose bleeds.
Remember
In the elderly age, group hypertension must always be ruled out.
If sinusitis is present in older age groups them diabetes mellitus is screened for, to ensure better management.
In the case of kids, nose-picking must be ruled out.
What causes nose bleeds in adults:
Hypertension
Trauma
Septal spur, deviation, septal perforation
Septal angioma/haemangioma
Rhinosporidiosis
Chronic sinusitis
Tumors
Fungal infection of nose and sinuses
Cocaine use
Extreme temperature
Barotrauma
Blood dyscrasias and leukemia
Infections like Dengue Haemorrhagic fever
Certain medications(NSAIDS, Warfarin, Aspirin, Clopidogrel)
Alcoholism and other causes of liver dysfunction
Certain Granulomatous diseases
Others.
Frequent nosebleeds are cause for concern
In all cases, in-person consultation by an ENT surgeon is needed for a full evaluation. The doctor will do a local examination of your nose, oral cavity oropharynx.
What your Doctor may ask
History about previous nasal bleeds or bleeding from other sides is important. Comorbidities like hypertension, diabetes, allergies, blood dyscrasias, fever need to be ruled out. Any history of forceful nose blowing or nose picking is vitally important and the nasal examination gives clues about the latter.
A family history of nose bleeds needs to be asked for and in the presence of fever, several more questions are asked.
The systemic examination will include measuring your BP and checking for any bruising petechiae and a few other things which are beyond the scope of discussion here.
Investigation
In case of acute nasal bleeding which is recurrent, persistent to not stopping needs urgent visit to an Emergency facility of a well-equipped hospital.
Computer tomography (CT scan) with or without contrast may be needed for the nose and Paranasal sinuses. A CT of the brain may also be needed to rule out any associated intracranial bleed.
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A detailed blood workup, ECG is carried out to screen for infectious diseases and systemic causes.
Nasal endoscopy may be carried out as a diagnostic or therapeutic tool depending on the condition.
Nose bleed treatment often needs a hospital setup and is best done by a professional. Read about some of the ways of nasal packing in this post.