Nosebleeds - the Good, the Bad, and the Ugly

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Dr. Peter Shepard of Southwestern Ear, Nose and Throat breaks down the myths about nosebleeds and offers tips and solutions on how to handle getting through nosebleed season.

Dr. Peter Shepard of Southwestern Ear, Nose and Throat - Santa Fe, NM

Dr. Peter Shepard of Southwestern Ear, Nose and Throat - Santa Fe, NM

"The best treatment for nose bleeds is avoiding them in the first place."

This is the season for nosebleeds. When the furnace fires up and the humidity drops, the nose is most vulnerable. Nosebleeds can range from a simple, brief annoying amount of bleeding (the good), to persistent, steady bleeding (the bad), to life-threatening bleeding (the ugly).

The nose has a collection of blood vessels called Kiesselbach's plexus. This area is located at the front of the septum, the cartilage that divides the nose. Vessels from several different main trunks all meet in this spot and are very close to the surface. This is also the area of the nose that tends to dry out the most. If the surface cracks, the vessels will bleed. The size of the vessels determines how bad the bleeding is. People are more at risk if they have high blood pressure, take blood thinners, use oxygen, or have a deviated nasal septum.

The best treatment for nosebleeds is avoiding them in the first place. Unless you can take an extended trip to Hawaii, you'll want to work on improving the humidity inside your nose. A humidifier in the bedroom, Vaseline applied to the nostrils, and saline sprays can all help. The biggest mistake I see is how these are used. The average indoor humidity where I live in northern New Mexico is 13%, whereas 45% is considered ideal. The average bedroom requires at least a gallon of water a day to achieve this, depending on size and drafts. I recommend an evaporative humidifier that has at least a five gallon capacity, will measure humidity, and is adjustable. In regards to Vaseline, the best method is simply to apply some at the front of your nostril twice a day. Saline spray can be kept with you and used throughout the day.

If you do have a bleed, a few simple things will usually stop it. Applying pressure by squeezing the soft part of the nose between your thumb and index finger is very effective. It is a dangerous myth that holding your head back will stop a bleed. Lean forward so you don't swallow any blood. If that is not enough, oxymetazoline (Afrin) nasal spray can be a miracle drug for nosebleeds. It is a decongestant but works great for nose bleeds since it causes blood vessels to constrict. I tell adults who have persistent nose bleeds to blow the blood out of their nose, spray twice with oxymetazoline on the side of bleeding, then apply pressure for 15 minutes. This can be repeated once. If the bleeding persists (the bad or the ugly), then proceed to the Emergency Room. The bad or ugly bleeds may require packing or cauterization in the ER. For recurrent nose bleeds, a clinic consult with an ear, nose and throat physician is recommended so that a thorough exam and possible cauterization can be performed.

With these winter survival tips, I hope we can all enjoy the season nosebleed free.
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Dr. Shepard is an Ear, Nose and Throat Physician with Southwestern Ear, Nose and Throat Associates. Known for comprehensive ear, nose and throat care, SWENT features centers in audiology and hearing aids, sleep disorders, allergies, and same day surgeries-the only all-inclusive office of its kind in New Mexico. SWENT has offices in Santa Fe, Los Alamos, Espanola and Las Vegas.

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