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Spokane, Washington  Est. May 19, 1883
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Son’s nosebleeds are a nuisance

Peter H. Gott, M.D.

DEAR DR. GOTT: I am writing due to my concern over my son’s frequent nosebleeds. He has had them nearly all of his life. Otherwise, he is a healthy 14-year-old.

We recently saw his pediatrician and an ear-nose-and-throat specialist to have some tests done to make sure that there are no blood problems or tumors in his nose and sinus cavity. Everything was found to be normal, so we went ahead and had his nose cauterized, which I was told might fix the problem, but there was no guarantee. Unfortunately, the procedure didn’t work and appears to have made the bleeds worse.

My son now has nosebleeds in the middle of the night and more than once during the day. They have become a nuisance to both of us.

We were told to rub petroleum jelly in his nasal passages, spray saline in his nose, and place a humidifier in his room in order to keep his sinuses moist. We have done this, but with no success.

DEAR READER: There are two types of nosebleeds. The first is anterior, which makes up more than 90 percent of cases. This variety is usually caused when blood vessels on the nasal septum rupture. They are normally easy to control. The second is posterior, which tend to occur more often in older people. They are typically caused when an artery in the back of the nose ruptures. They are often complicated and may require hospitalization in order to bring the bleeding under control.

Most nosebleeds do not require hospitalization or physician treatment. Home treatment involves remaining calm, sitting up straight, leaning forward slightly to prevent swallowing blood, and pinching the nostrils together for 10 minutes. If blood gets into the mouth, try to spit it out. Ice packs don’t help, and cold or dry air may worsen symptoms.

If bleeding has not stopped after 10 minutes, it is time to see a doctor. This is best achieved by visiting the local emergency room. There, the nose may be cauterized if the source of the bleeding can be seen easily. Nasal packing may also be done.

For anterior nosebleeds, this may be accomplished using petroleum gauze, synthetic sponge packs or balloon nasal packs that put pressure on the nose from the inside. They are often uncomfortable and must be left in place for 48 to 72 hours, meaning the patient goes home with the pack in place and must return to have it removed. Antibiotics may be prescribed to prevent infection, because the pack also blocks the flow of mucus.

Posterior nosebleeds are often treated with nasal packs as well, but because the bleeding originates in the back of the nose, they are slightly different. Most commonly, a balloon pack is used. Because of the location, these packs are uncomfortable and require painkillers or sedatives and hospitalization to monitor the patient closely because the risk of infection or breathing problems is high. If packing does not stop the bleeding after 48 to 72 hours, arterial embolization (causing a clot to form to stop the bleeding) or other surgical procedures may be needed.

Because your son has such frequent nosebleeds, I urge you to return to his pediatrician and request testing for underlying problems. Perhaps something as simple as a vitamin deficiency is to blame. His quality of life is being affected, and he may be suffering unwanted consequences from his frequent blood loss, such as anemia.

To provide related information, I am sending you a copy of my Health Report “Blood – Donations and Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

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