Nasal Issues: Causes and Treatments for Nosebleeds

Nasal issues

Hello Doctor: A few days ago, after taking a shower, I noticed a small amount of blood coming from my left nostril while wiping my nose.
Upon examining my left nostril with a flashlight, I found that the area near the nasal bone was red and swollen, while the right nostril appeared normal.
The next day, I visited a nearby ENT clinic, where the doctor diagnosed me with rhinitis and prescribed a five-day course of oral medication along with a topical ointment.
During the course of taking the medication and applying the ointment, I experienced nasal congestion, which sometimes alternated between nostrils, or occasionally affected both sides, but it was never too severe, and I could still breathe.
When applying the ointment to the left nostril with a cotton swab, there was blood on the swab.
Blowing my nose gently did not produce blood initially, but after two or three times, there would be some.
The right nostril has not bled at all, though it occasionally feels congested.
I am nearing the end of the five-day medication and have continued to apply the ointment, but the area near the nasal bone in my left nostril remains red and swollen with no signs of healing.
Could you please explain what might be happening, Doctor?

Lai, 20~29 year old female. Ask Date: 2018/09/08

Dr. Ji Zhaoyun reply Otolaryngology

Hello, based on your description, there are many causes of nosebleeds, with the most common being thin nasal mucosa leading to bleeding from forceful nose blowing.
However, other potential causes include nasopharyngeal or nasal cavity tumors (such as nasopharyngeal carcinoma), sinusitis, vestibular folliculitis, fungal infections, allergic rhinitis, hypertension, coagulopathy, and nasal trauma, among others.
It is advisable to consult an otolaryngologist, and an endoscopic examination may be beneficial depending on the situation.
If oral medication is ineffective, consideration can be given to using medications or laser treatment to cauterize the frequently bleeding nasal blood vessels.
Wishing you peace and health.
This is purely an exchange of ideas; all decisions should be based on the physician's actual examination.
Sincerely, Dr.
Chi Chao-Yun, Head of the Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2018/09/08

More Info

Nosebleeds, or epistaxis, can be a common and often benign condition, but they can also indicate underlying issues that may require further evaluation. Based on your description, it seems that you are experiencing a localized issue in your left nostril, which is red and swollen, and you have noted the presence of blood on the cotton swab after applying medication. Let's delve into the potential causes and treatments for your condition.

Causes of Nosebleeds
1. Nasal Inflammation: The redness and swelling you observe could be due to inflammation of the nasal mucosa, often resulting from conditions like allergic rhinitis or non-allergic rhinitis. This inflammation can lead to fragile blood vessels that are more prone to bleeding.

2. Dry Air: If you live in a dry climate or if the air in your home is dry (especially during winter months when heating systems are used), this can dry out the nasal membranes, making them more susceptible to bleeding.

3. Infection: Sinus infections or upper respiratory infections can cause nasal congestion and inflammation, leading to nosebleeds. The presence of blood on the cotton swab may suggest that the mucosa is irritated or damaged.

4. Nasal Trauma: Even minor trauma, such as vigorous nose blowing or picking, can lead to bleeding. If you have been cleaning your nose frequently, this could contribute to the irritation and subsequent bleeding.

5. Structural Issues: Conditions such as a deviated septum or nasal polyps can lead to chronic nasal obstruction and inflammation, which may predispose you to nosebleeds.

Treatment Options
1. Medications: Since your doctor has already prescribed oral medications and a topical ointment, it is essential to continue using them as directed. These medications may help reduce inflammation and promote healing of the nasal mucosa.

2. Humidification: Using a humidifier in your home can help maintain moisture in the air, which may alleviate dryness in your nasal passages and reduce the frequency of nosebleeds.

3. Nasal Saline Sprays: Over-the-counter saline nasal sprays can help keep the nasal passages moist and may aid in healing the irritated mucosa.

4. Avoiding Irritants: Try to avoid exposure to irritants such as smoke, strong odors, or allergens that could exacerbate your nasal inflammation.

5. Gentle Nose Care: Be gentle when blowing your nose or cleaning your nostrils. Avoid picking your nose, as this can lead to further irritation and bleeding.

6. Follow-Up Care: If your symptoms persist despite treatment, or if you experience frequent nosebleeds, it is crucial to follow up with your ENT specialist. They may recommend further evaluation, such as nasal endoscopy, to assess the nasal passages and identify any underlying issues.

When to Seek Immediate Medical Attention
You should seek immediate medical attention if you experience any of the following:
- Frequent or severe nosebleeds that do not respond to pressure or home treatment.

- Nosebleeds accompanied by other symptoms such as dizziness, weakness, or significant blood loss.

- Signs of infection, such as fever or worsening pain.

In conclusion, while nosebleeds can often be managed with conservative measures, it is essential to monitor your symptoms closely and maintain communication with your healthcare provider. Persistent symptoms warrant further investigation to rule out any serious underlying conditions.

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