Nose Surgery to Stop Nosebleeds?

Question

Can nose surgery be done to stop frequent nose bleeds? I have never broken my nose, and I've had it looked at by doctors who have given me medicine, none which have ever worked to stop the bleeding. Can surgery be done to stop this, and if so who should I go to and what is it called?

Michael G. Brandt, MD · Answer

Nose-bleeds can be a severe nuisance.  The best method of managing minor nuisance nose-bleeds involves moisturizing your nose.  

	The most frequent cause of minor nose-bleeds is digital trauma (picking), or severe dryness of the nose - frequently caused by dehumidifiers/heaters in the winter months.  The best method of preventing minor nose-bleeds is by moisturizing the nose.  This is done with a combination of nasal saline spray and vaseline (petroleum jelly).  I typically advise patients who have recurrent nosebleeds to apply vaseline to their nose two to three times per day for the first two weeks and then once a day (prior to bed) thereafter.  Just a small pea-sized amount to the nasal septum (divider of the nose).  This is applied with a finger and you don't need to be applying it far back - it tends to work its way back throughout the day.  Additionally, I suggest using over the counter nasal saline spray (mist spray preferred) every 1 - 2 hours (while awake) for the first two weeks and then tapering down to every 4- 6 hrs (while awake) thereafter.  Two sprays to each side of the nose.

	The above won't help during an acute nose-bleed.  To treat this, stop all activity and simply apply pressure to the front of your nose and lean forward (so the blood doesn't drain to the back of your throat).  Holding the nose for 5 full minutes is usually adequate to stop the bleed.  Should you have a substantial bleed that continues longer than 10 minutes, I would advise you to go to your nearest emergency department.  

	Finally, if the moisturizing regime does not work for you (it typically requires a few weeks to work), you are experiencing substantial nose-bleeds, or you are simply concerned and want definitive advice, you should visit with your local Otolaryngologist - Head and Neck Surgeon (ENT).  A thorough evaluation is required to determine the source of the bleed.  Most commonly, nose-bleeds are caused by a prominent vessel on your septum combined with thin lining and a dry nose.  This is treated with silver nitrate or electric cautery (this can be done in the office) to shrink the vessel and thicken up the nasal lining.  Rarely, the nose-bleeds are a sign of something more substantial than a prominent vessel and only through a thorough evaluation by an Otolaryngologist can this be determined.  I would encourage you to visit with your local Otolaryngologist for an assessment and definitive advice.

Babak Larian, MD · Answer

First you need to find the source of the bleeding, and then correct it.  Depending on the location and level of severity of the source, this may be able to be done as a quick in-office procedure or would require an actual surgery.  But either way it is treatable.  Find an ENT (ear nose throat) doctor in your area, or if you are local to LA feel free to come into my office!

William Portuese, MD · Answer

The majority of nosebleeds are from bleeding at the anterior portion of the septum.  Cauterization of this area of the nose is done in an office setting under topical anesthesia with silver nitrate.  If the patient fails silver nitrate therapy, then surgical electrocautery is performed under local anesthesia; rarely does it require general anesthesia.  Surgical electrocautery will enable the surgeon to cauterize blood vessels on a permanent basis to be done either as a clinic procedure or as a nurse station procedure.  The patient should not be taking any blood thinners, such as aspirin, which can contribute to the nosebleeds. Surgery  is the last resort to stop a nosebleed situation

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