Fewer than one in 10 people hospitalized for an unexplained nosebleed requires invasive treatment to stop the bleeding, a review of nationwide data has found.
About 38 percent of people with nosebleeds so bad they are admitted to the hospital wind up having their nosebleed resolved with little or no treatment, according to the study published online Oct. 17 in the journal JAMA Otolaryngology — Head & Neck Surgery.
Clinicians successfully treated another 53 percent of nosebleed patients either by stuffing the nose with cotton or by cauterizing a broken blood vessel using heat, electricity or chemicals.
Only about 8 percent of hospitalized nosebleed patients needed treatment through surgery or by embolization, a process in which doctors seal off the bleeding vessel from within, the researchers found.
The small minority of patients who needed invasive treatment faced increased risk and expense, the data showed. For example, the odds of patients suffering a strokefollowing embolization were significantly higher than in patients who were treated by packing their nose with cotton.
Study co-author Dr. Jennifer Villwock said the results show why doctors like to proceed slowly when treating a bad nosebleed, giving the more conservative options a chance before opting for more invasive treatments.
“Sometimes it seems like we are putting patients through a lot, but we are doing it with their best interests in mind because the more invasive treatments are not without risk,” said Villwock, an otolaryngologist with the State University of New York-Upstate Medical University, in Syracuse. “If we can get it stopped at the bedside, that’s going to be best for all involved, but that can seem frustrating when your nose has been bleeding for hours.”
Three of every five people will suffer a nosebleed — also known by the medical term epistaxis — in their lifetime, Villwock said.
The nose contains many small blood vessels, and these can be ruptured easily, she said. Just the act of breathing can dry out and irritate the lining of the nose, particularly in low humidity or if a person is suffering from a cold or allergies.
Seasonal changes can also have an impact, an expert explained.
“This is the beginning of nosebleed season, as the weather gets cold and the heated air is on in most people’s houses,” said Dr. Lisa Liberatore, an ear, nose and throat specialist at the New York Head & Neck Institute at Lenox Hill Hospital in New York City. “We’re going to see several patients a day, and I’m sure the emergency room is going to get their fair share of nosebleeds.”
People also can suffer nosebleeds if they have taken a blow to the nose, are on a blood-thinning medication or have a cancerous lesion in their nose
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