You Ask , They Answer
Q
: What causes nosebleeds and why are children more susceptible to them ?
A
: The nose functions as a conduit for getting air into the body and humidifying it before reaching the lungs . To do this , it requires an ample blood supply from the capillaries , which are little vessels just beneath the lining of the nose . Right at the front of the septum , which is the interior partition of the nose , there is a particularly large number of these capillaries .
Children , in particular , suffer from nosebleeds for various reasons . For a start , they pick their nose a lot . They ’ re also more prone than adults to getting colds and runny noses . We ’ re also seeing more kids these days with nasal allergies , which causes the lining of the nose to get inflamed and makes the capillaries more prone to bleeding .
Q
: For what reasons might adults suffer from nosebleeds ?
A
: What you see more commonly in adults than children is a deviated nasal septum where the centre partition goes off centre to the right or left . When the deviation is at the front of the nose , where the air comes in , there may be turbulence in the airflow . This turbulence may cause drying of the mucosa where the deviation is , making the person more prone to ulceration and bleeding .
Some nosebleed sufferers may have had nasal trauma from a fall , sports injury , or accident . It could be something as simple as a break in the lining of the nose or a trauma involving the paranasal sinuses , which are the air spaces around the nose within the skull . Any structural injury involving these bones could lead to a nasal bleed .
Both benign and cancerous tumours can also lead to nosebleeds . In teenage boys , in particular , there is a particular benign tumour called a nasopharyngeal angiofibroma that can cause nosebleeds , although this is not common and we do not see it in adults .
Other tumours in adults and children include nasopharyngeal carcinoma , a malignant tumour seen in middle-aged people with a racial predominance among Chinese , and hemangioma , which is a benign tumour that is full of blood vessels that presents in children more commonly than adults .
Those with uncontrolled hypertension can suffer from nasal bleeding as high blood pressure can cause the capillaries to rupture . Medications can be a secondary factor that triggers the bleeding . For example , if the patient is on aspirin or warfarin , they will not naturally bleed from the nose , but a trauma or a procedure done to the nose will make them more prone to bleeding .
Q
: How should a nosebleed be stopped ?
A
: The first thing to do would be to pinch the nose over the vestibule towards the septum in the middle and hold it with the thumb and index finger while looking downwards and keeping the mouth open . By doing so , the capillary is compressed and it stops the bleeding . Looking down is important because it prevents you from swallowing the blood that will come out through the mouth . It is better to know how much bleeding there is and then spit it out . If that doesn ’ t stop the bleed , place ice over the bridge of the nose to cause the blood vessels to constrict . If that doesn ’ t work , go to the hospital .
Q
: Can nosebleeds be a cause for concern ?
A
: Regular prolonged nosebleeds may be a cause for concern , for all age groups . A regular nosebleed would be when it happens a few times a week over a period of weeks . Sudden onset nosebleeds should also be noted . This may happen in patients who rarely have nosebleeds who find they ’ ve started getting them over a period of time .
Dr Anura Michelle Manuel
Dr Anura Michelle Manuel is an otolaryngologist at Prince Court Medical Centre in Kuala Lumpur .
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12 OCTOBER 2021 GlobalHealthAsiaPacific . com