Nosebleeds: Causes, Symptoms, and Treatment Insights - Otolaryngology

Nosebleed

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Hello Doctor: To ensure you have a clear understanding of my symptoms, I will provide a detailed account and hope you can share all relevant information.
I am here to consult about my nosebleeds.
Firstly, I have no history of nasal diseases and have not experienced a nosebleed for over 20 years; thus, the sudden occurrence of a nosebleed has left me quite bewildered.
Secondly, the incidents can be divided into two occurrences, and I will provide a complete account of both, summarizing their commonalities and differences to infer possible causes and eliminate unlikely ones.
Before asking my questions, I have already researched related issues, sought information, and visited a clinic; however, due to other cases not aligning perfectly, the authenticity of the information being difficult to discern, and some being quite severe, the physician I consulted could not clearly identify the problem, which brings me here to ask.
- First Incident: Date: May 20 of this year, around 3 AM.
Process: I was brushing my teeth when my right nostril suddenly started bleeding.
Outcome: I immediately visited an ENT clinic that afternoon, where I explained possible causes (trimming nasal hair), and the doctor indeed found a wound in that nostril.
I was prescribed hemostatic medication and given petroleum jelly to apply.
I completed the medication, but I stopped applying the petroleum jelly later as there was no further bleeding and it caused itching.
- Second Incident: Date: June 29 of this year, around 1 AM.
Process: I was sitting at my computer desk when my right nostril suddenly started bleeding.
Outcome: I had actually seen a doctor the day before (June 28) for other reasons, but not for a nosebleed.
One of the symptoms that day was "a metallic taste of blood in my throat, but no blood in my saliva." However, I did not take this lightly and arrived at the clinic before it opened.
During the consultation, the doctor connected the two incidents but did not elaborate much; the only finding was that I had a "deviated septum."
*Note: "a metallic taste of blood in my throat, but no blood in my saliva" → To clarify, there was no blood in my phlegm, saliva, or occasional nasal mucus.
During both consultations, the doctor attempted to palpate my neck area to ensure there were no foreign bodies; both times, nothing was found, thus preliminarily ruling out any masses.
Commonalities of the Two Nosebleeds:
1.
Both occurred at night.
2.
Both involved bleeding from the right nostril.
3.
The amount of bleeding was moderate, manageable (lasting less than half a minute).
4.
There were no actions directly causing the bleeding at the time (i.e., I was not picking or blowing my nose when the bleeding occurred).
5.
My emotional state was stable before and after the bleeding, with no other obvious physical abnormalities (excluding the sensation of dripping from the nose to the mouth and a feeling of chest tightness due to anxiety).
Differences Between the Two Nosebleeds:
There may be a connection to environmental factors such as temperature changes and dry weather that could lead to nosebleeds.
Thus, I will outline the environmental conditions during both incidents:
- On May 20, I was not accustomed to using air conditioning, so I only opened the windows for ventilation and used a fan, but it still felt dry and hot.
- On June 29, starting June 22, I became intolerant to high temperatures and began using air conditioning.
Although I did not feel dryness, it was certainly much more comfortable.
In summary, I have several questions:
Q1.
It is known that a deviated septum does not necessarily require surgery.
Is there a direct correlation between nosebleeds and a deviated septum?
Q2.
There are various opinions online, with the most common being "frequent bleeding should be noted." While individual constitution and recovery speed vary, is there a more specific definition of "frequent" (how often should one bleed)?
Q3.
While a significant amount of bleeding would certainly raise alarms, it is better to be cautious to avoid missing treatment opportunities.
In my case, the bleeding can be controlled in a short time; could there still be potential underlying issues? (For example, signs of certain diseases?)
Q4.
Based on my case, the interval between the two nosebleeds was over a month, suggesting that the wound may take longer than a month to heal.
How long does it typically take for microvascular ruptures in the nasal cavity to heal and return to normal?
Q5.
I tend to be impatient, and the resulting rapid heartbeat often causes a feeling of chest pressure, leading me to consider that excessive heat could be a cause of my nosebleeds.
However, I have not experienced nosebleeds due to excessive heat in the past; does this mean that these two incidents are unrelated to heat?
I kindly ask for your responses, and I greatly appreciate your help.

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Chen, 20~29 year old female. Ask Date: 2022/06/29