Dear Doctors: I am a 76-year-old woman not prone to nosebleeds. However, I recently started having heavy ones. Thrombin spray helped, but only for a week. A CT scan was normal. What can be done? A friend with nosebleeds had his nose cauterized. Might that be helpful for me?
Dear Reader: When viewed from the outside, our noses look fairly basic. But peek inside, and things get remarkably complex. The bones, flesh and cartilage of the visible nose serve as a protective entryway to a series of hidden passages and chambers. These include the airways that moisten and filter the air we inhale and the olfactory system, made up of the nerves, cells and organs that enable us to smell. Lining the interior of the nose are specialized cells and glands, known collectively as the mucosa, which keeps these inner surfaces moist. This layer is served by a rich network of tiny blood vessels, which, if ruptured, cause a nosebleed.
Nosebleeds (the medical term is “epistaxis”) often occur due to physical injury, such as a bump or a fall, or blowing the nose too hard or too often. Inflammation from a respiratory illness, infection or allergy can cause a nosebleed. So can dry air, which dehydrates the tissues of the mucosa and can cause them to crack. The physical changes that take places as we age can also make blood vessels in the nose more fragile. In fact, nosebleeds are fairly common in older adults.
The thrombin spray you were treated with is one of several medications used to encourage what is known as a coagulation cascade. It works by activating proteins known as clotting factors, which stanch the flow of blood. But sometimes blood vessels in the nose grow fragile and are easily damaged, which leads to repeated nosebleeds. When this occurs, cauterization, the treatment your friend underwent, can be helpful. Your ENT will let you know if you are a good candidate.
Cauterization involves the use of either a chemical swab or an electrical current to seal off the affected blood vessels in the nose. This creates scar tissue, which helps prevent further nosebleeds. The doctor begins with an exam to identify the cautery site. On the day of the procedure, the inside of the nose is numbed with an anesthetic. The doctor will then cauterize the affected area, a process that takes about 10 minutes. Aftercare often includes an ointment to keep the interior of the nose moist and to prevent infection. Healing occurs over the course of two weeks. After the procedure, mild pain and itching can occur. The scent organs are located deeper in the nose than the site of cautery, and thus are not adversely affected.
Nosebleed aftercare is important. Always be gentle when blowing your nose. Keep nasal tissues moist with humidifiers. The saltwater used in nasal lavage can have a drying effect, so use sparingly. So can the chemicals in swimming pools. Nonsteroidal anti-inflammatory medications, such as aspirin, can also add to risk of bleeding, so when pain meds are needed, choose an alternative.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
