About Nosebleeds

Nosebleeds (aka epistaxis) are the active loss of blood from the tissue that lines your nose. Blood flows from either one or both nostrils.

Dry air is the most common cause of nosebleeds, as it irritates and dries out the nasal membrane. The nasal blood vessels are delicate and close to the surface, making them more susceptible to injury and bleeding.

Other common causes include local trauma, nose picking, and sinus infections. 

Nosebleeds are most commonly the result of bleeding from the front of the nose. In this area, there is a fragile lattice of blood vessels called Kesselbach’s Plexus. The purpose of this plexus is to help keep the air that flows through the nose from drying out the skin inside the nose too much. Certain conditions can cause this area of blood vessels to bleed, such as trauma from repeated manipulation with fingers, dry environment, use of home oxygen therapy such as a nasal cannula or appliances for obstructive sleep apnea (BiPaP or CPAP masks), a loss of strength in the blood vessels throughout the body (common with aging and hypertension), blood-thinning medications such as aspirin, Coumadin or Plavix, and blood disorders affecting coagulation such as cancers and leukemias.

There are other more serious types of nosebleeds that are the result of bleeding further back in the nose from one of the arteries that deliver the blood supply to the nose and sinuses. These types of nosebleeds are more difficult to control and usually require a visit to a physician or emergency room for nasal packing or cauterization.

Hereditary Hemorrhagic Telangiectasia (HHT) or Osler-Weber-Rendu Syndrome is a genetic disorder that affects approximately 1 in 5,000 people. It is a disorder of the capillaries causing small blood vessel nests which are very fragile and prone to rupture. Although these telangiectases can be throughout the body, the most common problem is recurrent nosebleeds. The pattern of inheritance is autosomal dominant with variable penetrance. This means that multiple people in the same family may have HHT, but the severity varies from person to person. Some family members may have mild nuisance nosebleeds, whereas others may have severe life-threatening nosebleeds.