Nosebleeds and Ear Issues: When to Seek Further Evaluation

Q: Nosebleeds and Ear Issues: When to Seek Further Evaluation

Hello： Common nosebleeds are still caused by the rupture of microcapillaries. <br>If bleeding occurs frequently, it is advisable to consult a physician to discuss whether more prominent superficial microcapillaries should be treated with medication or laser therapy. <br>Wishing y

Ear, nose, and throat issues?

Hello, doctor.
Last year in April and May, I initially noticed blood streaks when I wiped my nose after crying too hard.
The next morning, my nose felt very itchy, so I rubbed it and ended up with a nosebleed.
I then went to see a doctor, who said there was a wound on the anterior part of my nose.
Upon self-examination, I noticed three prominent capillaries in that area, but the wound seemed difficult to heal and continued intermittently until August.
During this time, I also underwent a nasopharyngoscopy, which was deemed normal.
In October, I experienced tinnitus in my right ear and had another endoscopy, both through the nose and mouth, along with ear pressure tests, all of which were normal.
After a week of medication, I underwent two hearing tests.
The first was before taking the medication, and the second was after.
The second hearing test showed normal results.
However, even now, in quiet moments or while sleeping, I still hear a faint beeping sound, but it does not affect my daily life.

On the morning of January 2nd, I suddenly felt a wet sensation at the front of my nose without having touched it, and upon inspection, I found I had a nosebleed, which stopped quickly on its own.
I returned to the ENT specialist, who performed another endoscopic examination using two different instruments through my nose.
The doctor said everything still looked normal and could not find the bleeding point.
They suggested that the nosebleeds might be due to the dry weather.

I would like to ask if I need to undergo any further examinations.
Upon inspecting both nostrils, I still see the three prominent capillaries on the left side.
Could the bleeding be originating from those capillaries? Is there a way to manage or treat these capillaries? Thank you.
I forgot to mention that I have seen three different doctors during this time, all of whom performed endoscopic examinations and reported normal findings.

Xiong, 30~39 year old female. Ask Date: 2018/01/03

Dr. Zheng Jueyi reply Otolaryngology

Hello: Common nosebleeds are still caused by the rupture of microcapillaries.
If bleeding occurs frequently, it is advisable to consult a physician to discuss whether more prominent superficial microcapillaries should be treated with medication or laser therapy.
Wishing you safety and good health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2018/01/03

More Info

When it comes to understanding nosebleeds and ear issues, it’s essential to consider the underlying causes and the appropriate steps for evaluation and management. Based on your description, you have experienced recurrent nosebleeds and ear ringing (tinnitus), which can be concerning and warrant further investigation.

Understanding Your Symptoms
1. Nosebleeds: The occurrence of nosebleeds, especially when associated with dryness or irritation, is quite common. The nasal mucosa is rich in blood vessels, particularly in the anterior part of the nasal cavity, where the Kiesselbach's plexus is located. This area is prone to bleeding, especially in dry environments or with trauma (like vigorous nose blowing). If you have visible blood vessels and recurrent bleeding, it could be due to these vessels being fragile or irritated.

2. Ear Issues: The tinnitus you are experiencing, particularly the ringing sound that occurs in quiet environments, can be linked to various factors. It might be related to the ear's auditory system, including the inner ear or auditory nerve, or it could be a secondary effect of nasal issues, such as eustachian tube dysfunction. The eustachian tube connects the middle ear to the back of the nose and helps equalize pressure. If it is not functioning properly, it can lead to a sensation of fullness in the ear and possibly contribute to tinnitus.

When to Seek Further Evaluation
Given that you have already seen multiple specialists and undergone several examinations, including nasal endoscopy and hearing tests, it seems that the initial evaluations have not revealed any significant pathology. However, if your symptoms persist or worsen, consider the following:
- Persistent Nosebleeds: If the nosebleeds continue despite treatment and lifestyle modifications (like using a humidifier in dry environments), you might want to consult an ENT specialist who can perform more specialized procedures, such as cauterization of the blood vessels if they are indeed the source of bleeding. This is particularly relevant if the visible blood vessels are causing recurrent bleeding.

- Tinnitus: Since your tinnitus is still present, albeit not significantly affecting your daily life, it may be worthwhile to explore further evaluations. Audiologists can conduct more comprehensive tests to assess the nature of your tinnitus and its potential causes. Sometimes, tinnitus can be linked to hearing loss, even if it is not apparent in standard tests.

Management Strategies
1. For Nosebleeds:
- Moisturization: Use saline nasal sprays or gels to keep the nasal passages moist.

- Avoid Irritants: Stay away from smoke, strong odors, and allergens that can irritate the nasal mucosa.

- Gentle Nose Blowing: Avoid forceful nose blowing, which can exacerbate bleeding.

2. For Tinnitus:
- Sound Therapy: Using background noise or white noise machines can help mask the ringing.

- Cognitive Behavioral Therapy (CBT): This can help manage the emotional response to tinnitus.

- Hearing Aids: If there is any degree of hearing loss, hearing aids can improve auditory input and may reduce the perception of tinnitus.

Conclusion
While your current evaluations have not indicated any serious issues, the persistence of your symptoms suggests that ongoing monitoring and possibly further specialized assessments may be beneficial. It’s crucial to maintain open communication with your healthcare providers and discuss any changes in your symptoms. If you feel that your concerns are not being adequately addressed, seeking a second opinion from another ENT specialist or an audiologist may provide additional insights and management options.

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