October 18, 2013
News Review From Harvard Medical School -- Treatments for Worst Nosebleeds Compared
Fewer than 1 out of 10 nosebleeds that don't stop at home require the most extreme treatments at the hospital, a study finds. The study used hospital data on more than 57,000 patients who were treated for nosebleeds. All occurred without any known cause. Hospital staff stopped the bleeding in about 38% of the cases with little treatment. Another 53% were treated either by stuffing the nose with cotton or by cutting off the bleeding vessel (cauterizing) with heat, electricity or chemicals. Nearly 5% had surgery to tie off the blood vessel. Another 3% had embolization. This procedure plugs the blood vessel with a sealant. These two treatments cost more and have more risks than the others. About 1.3% of those who had surgery died. That was twice the death rate of nasal packing. Strokes occurred in 1.5% of those who had embolization. Almost all nosebleeds can be stopped at home. Researchers said only about 6% need a doctor's attention. About 0.2% require a stay in the hospital. The journal JAMA Otolaryngology -- Head & Neck Surgery published the study. HealthDay News wrote about it October 17.
By Mary Pickett, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
A new study puts nosebleed treatments in the spotlight. The study says that a variety of treatments used by doctors all seem to be roughly equal in their rate of success.
If you are looking for ways to take care of your next nosebleed at home, don't get too excited about the treatments in this study.
Doctors treat a specific kind of nosebleeds. They treat nosebleeds that do not stop at home. The treatments seen in this study are much more extreme than most nosebleeds require. And most of them cannot be used at home.
Several treatments were compared. They included:
- Packing the back of the nose with gauze
- Using cautery (burning a blood vessel with electricity or chemicals to make it stop bleeding)
- Using surgery to tie off an artery
- Blocking the artery with a plug of gelatin sponge or other material (embolization)
These treatments all work well. Surgery and embolization cost more. Embolization also had some worrisome side effects. In rare cases, nerve damage or stroke can occur. Embolization required costly imaging (a CT scan with dye). Based on this study, embolization should not be the treatment your doctor tries first.
What Changes Can I Make Now?
In more than 9 out of 10 nosebleeds, the blood comes from a leaking vessel along the bendable soft cartilage in your nose. This is called an anterior nosebleed.
You can stop almost any anterior nosebleed at home. Treat every nosebleed as if it is an anterior nosebleed because you will be right 94% of the time.
There is one best way to stop a nosebleed at home. Just pinch your nose firmly in the right place. Then hold the pinch long enough to stop the bleeding.
Here's how to do it:
- First, nod your head forward. This prevents blood from going down the back of your throat, where it could cause choking.
- To find your pinching position, start at the very top of the nose. Slowly slide your fingers down the nose, with your index finger on one side and your thumb on the other. You should feel a sudden drop-off at the lower edge of the bones. Below this edge, the nose is bendable because it has soft cartilage.
- Pinch just below this bony edge and well above your nostrils. You should feel a broad, curved edge of bone above and against your pinching fingers. Pinch far enough back on the nose that you could easily wiggle it with your fingers.
- Include a broad area of your nose in your pinch. Press both sides of your nose firmly against the septum. This is the cartilage in the middle of your nose. Nosebleeds almost always come from the septum. Pinching uses the sides of the nose to put pressure on the septum. Direct pressure stops bleeding.
- Even if you know what side of the nose you are bleeding from, pinch from both sides. This is the best way to put pressure on the septum.
- If it feels like your bleeding has stopped, you are pinching in the correct place.
- Hold your pinch at least five minutes before you release. You may need to repeat this for another five minutes.
If you can't stop your nosebleed within 20 minutes, you will need urgent medical care. Some nosebleeds that won't stop easily are "posterior" nosebleeds. They come from a blood vessel deeper in the nose, near the entrances to your sinuses. These always require advanced treatments by a doctor.
Drugstores sell packing materials to treat nosebleeds. I do not recommend using them at home. It is easier for you to know that you have stopped your nosebleed if you are using a pinch.
When doctors pack a stubborn nosebleed, they may need to pack the posterior nose. This is uncomfortable. It also requires lubricant. And you usually will receive antibiotics to prevent a sinus infection. Posterior nose packing can't safely be removed at home, so you need a follow-up visit.
What Can I Expect Looking to the Future?
Most people have at least one nosebleed in a lifetime. If you have had several nosebleeds, is there a way you can prevent them?
Simple things can help. Avoid nose-picking. You also can use petroleum jelly (such as Vaseline) at the opening of the nose to prevent dryness.
If you have frequent nosebleeds, check with your doctor to rule out a medical reason. You might need blood tests. Some medicines can make nosebleeds more frequent. They include aspirin, clopidogrel (Plavix), warfarin and nose sprays.