Tue, Apr 05, 2011 - Page 16 News List

Dealing with your bloody nose

Frequent nosebleeds can be a sign of a serious health problem, so avoid ‘digital manipulation’ and see a doctor if needed

By Jane E. Brody  /  NY Times News Service, New York

Graphic: TT

Nosebleeds, like noses, come in varied forms, and the number of sufferers is growing as the population ages. Millions of them rejoice at this time of year, when the most frequent cause — winter’s dry, heated indoor air — begins to yield to the warm, moist air of spring.

Four years ago Charles Kingson, a New Yorker in his 70s, experienced a frightening series of nosebleeds that initially proved hard to control. Eventually Kingson found a doctor who stopped the bleeding, and he has since learned how to prevent it from recurring.

But Kingson also found that several of his friends also were similarly plagued, and none knew why — or what to do about it.

Nosebleeds most often afflict older adults and young children. Among the young, Alan Lipkin, an otolaryngologist in Denver, told me, “digital and other manipulation” is the usual cause. Translation: nose-picking or putting foreign objects in the nose, behaviors that most parents are eager to discourage.

Of course, some adults also engage in “digital manipulation,” especially when winter dryness turns nasal mucus into irritating crusts that can impair breathing. And nosebleeds in young children may be caused by nasal dryness, as they often are in older adults.

Among both adults and children, however, there are many other causes worth knowing about. And while most nosebleeds can be self-treated or prevented with simple home remedies, frequent nosebleeds should never be taken lightly. They can be a sign of a more serious problem, like leukemia, a nasal tumor or a blood clotting disorder, and should be brought to a doctor’s attention.

Most often, nosebleeds originate in the front of the nose, where many small blood vessels near the surface of the nasal septum (the tissue that divides the two nostrils) warm the air you inhale. These so-called anterior nosebleeds are annoying, and they can be frequent and frightening, on occasion producing as much as 30 milliliters of blood.

But anterior nosebleeds are rarely dangerous. Of greater concern are the severe, potentially dangerous nosebleeds that originate in larger blood vessels far back in the nose. So-called posterior nosebleeds are relatively uncommon, and home remedies are ineffective. They require prompt medical attention and more involved treatment, perhaps under anesthesia in a hospital.

Here are some common causes:

■ Medications that “thin” the blood, like warfarin (Coumadin); clopidogral bisulfate (Plavix); nonsteroidal anti-inflammatory drugs, or Nsaids, like ibuprofen and naproxen; and aspirin, including “baby” aspirin that many older adults take to help prevent heart disease and colon cancer.

■ Topical medications that irritate the nasal passages, like corticosteroid and antihistamine sprays, and overuse of decongestant nasal sprays.

■ Allergies and their consequences – frequent sneezing and overly aggressive nose blowing.

■ Upper respiratory infections involving the nose or sinuses.

■ Nasal trauma from a direct or indirect blow to the nose, including a broken nose.

■ A deviated septum, which can impede breathing through one nostril and overwork the other.

■ Abrupt changes in air pressure.

■ High blood pressure and atherosclerosis, which are more common with age, can be a contributing factor in adults.

■ Other disorders, like liver or kidney disease, chronic abuse of alcohol and sniffing cocaine, also can result in nosebleeds.

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