A nosebleed, or epistaxis, is something most of us have experienced at some point in our lives. For many, it’s just a nuisance, a few minutes of pinching the nose, a tissue or two, and the bleeding stops. But not all nosebleeds are harmless. In some cases, they may indicate a deeper issue, particularly if they occur frequently, are severe, or happen in specific age groups.
This article will explore the different causes of nosebleeds in children and adults, outline first aid measures for managing simple bleeds, discuss when nosebleeds may be cause for concern, and highlight treatment options such as nasal cautery. We’ll also cover potentially serious conditions like juvenile angiofibromas in children and nasopharyngeal cancer in adults. If you or your child experiences recurrent or unexplained nosebleeds, a consultation with an ENT doctor in Singapore is strongly advised for a comprehensive evaluation.
Why Do Nosebleeds Happen?
The inside of the nose is lined with a rich network of tiny blood vessels close to the surface, particularly in an area called Little’s area or Kiesselbach’s plexus, located in the front part of the nasal septum. Because these vessels are so delicate, they can rupture easily with even minor trauma or irritation.
Common causes of nosebleeds include:
- Dry air or air conditioning
- Frequent nose blowing (often due to allergies or colds)
- Nose picking (especially in children)
- Minor injuries or bumps to the face
- Use of nasal sprays or blood-thinning medications
In many cases, these are self-limiting bleeds that resolve with simple first aid. However, when nosebleeds are frequent, prolonged, or occur spontaneously, they may be a symptom of a more significant issue, and that’s when medical attention becomes essential.
First Aid for Nosebleeds: What You Should Do
Before jumping to worst-case scenarios, it’s important to know how to manage a simple nosebleed at home. Here’s a step-by-step guide that works for both children and adults:
- Stay calm – panic can elevate blood pressure and worsen the bleed.
- Sit upright and lean slightly forward. This prevents blood from flowing into the throat, which can cause nausea or vomiting.
- Pinch the soft part of the nose, just below the bony bridge, using the thumb and index finger.
- Maintain firm pressure for 10–15 minutes without letting go to check if it has stopped.
- Apply a cold compress to the nose or cheeks, the cold helps constrict blood vessels.
Avoid tilting the head back or lying down, as this can cause blood to flow into the throat. Once the bleeding stops, refrain from blowing the nose or strenuous activity for at least a few hours.
If bleeding continues for more than 20 minutes, or is associated with dizziness, weakness, or coughing/vomiting blood, seek immediate medical attention.
Nosebleeds in Children: What to Watch Out For
In children, most nosebleeds are caused by dry air, nose picking, or allergic rhinitis, which leads to frequent nose rubbing and blowing. However, in some rare cases, frequent or one-sided nosebleeds in boys, especially in their early teens, may signal a rare but serious condition called juvenile nasopharyngeal angiofibroma (JNA).
What is Juvenile Angiofibroma?
JNA is a benign but aggressive vascular tumour that occurs almost exclusively in adolescent males. It originates in the back of the nasal cavity and can cause:
- Repeated one-sided nosebleeds
- Nasal congestion or obstruction
- Facial swelling
- Hearing difficulties (due to Eustachian tube blockage)
Because of its tendency to grow and invade nearby structures, early diagnosis and management by an otolaryngologist is essential. Treatment typically involves imaging (MRI or CT scan) followed by surgical removal, sometimes preceded by embolisation to reduce blood flow to the tumour.
If your child experiences recurrent, unexplained nosebleeds, especially from one nostril, it’s important to rule out this and other less common causes.
Nosebleeds in Adults: When It’s More Than Just a Dry Nose
In adults, high blood pressure, nasal trauma, blood thinners, and chronic sinus issues are frequent contributors to nosebleeds. However, persistent or one-sided nosebleeds may indicate more serious concerns.
One important condition to consider, particularly in adults over 40, is nasopharyngeal carcinoma (NPC), a type of cancer that originates in the upper part of the throat behind the nose.
Warning Signs of Nasopharyngeal Cancer:
- Recurrent or unilateral nosebleeds
- Persistent nasal blockage, often on one side
- Hearing loss or blocked ear sensation
- Frequent headaches or facial pain
- Swollen lymph nodes in the neck
NPC is more common in certain parts of Asia, and early detection significantly improves outcomes. If these symptoms are present, especially in combination, prompt assessment by an ENT doctor is crucial.
When to See an ENT Doctor for Nosebleeds
While occasional nosebleeds are common and usually harmless, there are certain red flags that warrant a visit to an ENT specialist:
- Frequent nosebleeds (more than once a week)
- Prolonged bleeding (lasting more than 15–20 minutes)
- Bleeding from one nostril only, particularly in children or older adults
- Associated symptoms such as nasal obstruction, facial pain, or hearing changes
- History of bleeding disorders or use of blood-thinning medication
- A visible mass or growth inside the nose
An ENT doctor can perform a detailed nasal endoscopy, a painless procedure using a thin camera, to visualise the inside of the nose and nasopharynx. Imaging such as CT scans or MRI may be ordered depending on the findings.
Cauterisation: A Simple Treatment for Recurrent Nosebleeds
For patients with frequent nosebleeds due to fragile blood vessels in the nasal septum, nasal cautery is a safe and effective treatment.
Cautery involves sealing the bleeding vessel using a chemical agent (silver nitrate) or a thermal device. It is performed under local anaesthesia and takes only a few minutes in the clinic.
Benefits of cautery include:
- Long-term control of frequent bleeds
- Avoiding more invasive procedures
- Minimal discomfort and downtime
For optimal results, the procedure is often combined with moisturising nasal care (e.g. saline sprays, humidification) to prevent recurrence.
Identifying Underlying Causes of Nosebleeds
A key part of managing recurrent or severe nosebleeds is identifying and treating the underlying cause. This might include:
- Allergic rhinitis or chronic nasal inflammation
- Structural abnormalities such as a deviated septum or nasal polyps
- Systemic conditions like hypertension, clotting disorders, or liver disease
- Medications such as aspirin, warfarin, or certain nasal sprays
An experienced practice will take a comprehensive approach, starting with history-taking and physical exam, followed by investigations as needed. The goal is to provide both symptom relief and long-term prevention.
Practical Tips to Prevent Nosebleeds
For those prone to nosebleeds, here are some simple but effective strategies:
- Keep the nasal passages moist with saline sprays or humidifiers
- Avoid nose picking or aggressive blowing
- Treat underlying allergies or sinusitis
- Use nasal ointments or petroleum jelly to reduce dryness
- Stay well-hydrated and limit caffeine/alcohol (which can dry mucous membranes)
- Monitor and manage blood pressure regularly
Parents can help children reduce nosebleeds by trimming nails, discouraging nose picking, and maintaining a moist indoor environment.
Conclusion
Nosebleeds are common across all age groups, but understanding when they’re harmless and when they signal something more serious is key. From simple home care to advanced diagnostics, today’s management options are safe, effective, and minimally invasive.
If you or your child are experiencing frequent, severe, or unexplained nosebleeds, it’s time to consult with a doctor. Whether it’s a minor issue like fragile vessels or something requiring deeper investigation, it is recommended to consult an ENT specialist.