Fewer than one in 10 people
hospitalised for an unexplained nosebleed
requires invasive treatment to stop the bleeding, a review of nationwide data
About 38% of people with
nosebleeds so bad they are admitted to the hospital wind up having their
nosebleed resolved with little or no treatment, according to the study
published online in the journal JAMA Otolaryngology – Head &
treated another 53% of nosebleed patients either by stuffing the nose with
cotton or by cauterising a broken blood vessel using heat, electricity or
Only about 8% of
hospitalised nosebleed patients needed treatment through surgery or by
embolisation, a process in which doctors seal off the bleeding vessel from
within, the researchers found.
Increased risk and expense
The small minority of patients
who needed invasive treatment faced increased risk and expense, the data
showed. For example, the odds of patients suffering a stroke following
embolisation were significantly higher than in patients who were treated by
packing their nose with cotton.
Study co-author Dr Jennifer
Villwock said the results show why doctors like to proceed slowly when treating
a bad nosebleed, giving the more conservative options a chance before opting
for more invasive treatments.
"Sometimes it seems
like we are putting patients through a lot, but we are doing it with their best
interests in mind because the more invasive treatments are not without
risk," said Villwock, an otolaryngologist with the State University of New
York-Upstate Medical University, in Syracuse. "If we can get it stopped at
the bedside, that's going to be best for all involved, but that can seem
frustrating when your nose has been bleeding for hours."
Three of every five people
will suffer a nosebleed – also known by the medical term epistaxis – in their
lifetime, Villwock said.
The nose contains many
small blood vessels, and these can be ruptured easily, she said. Just the act
of breathing can dry out and irritate the lining of the nose, particularly in
low humidity or if a person is suffering from a cold or allergies.
Seasonal changes can also
have an impact, an expert explained.
"This is the beginning
of nosebleed season, as the weather gets cold and the heated air is on in most
people's houses," said Dr. Lisa Liberatore, an ear, nose and throat specialist
at the New York Head & Neck Institute at Lenox Hill Hospital in New York
City. "We're going to see several patients a day, and I'm sure the
emergency room is going to get their fair share of nosebleeds."
People also can suffer
nosebleeds if they have taken a blow to the nose, are on a blood-thinning
medication or have a cancerous lesion in their nose.
Almost everyone is able to
treat their nosebleed themselves, or receive successful outpatient treatment at
their doctor's office, an urgent-care clinic or an emergency room, the
researchers said. Only 0.2% of nosebleeds require hospitalisation, they said.
Risk of stroke
This study used nationwide
data provided by hospitals to review the care provided to those hospitalised
for a nosebleed. Researchers looked at more than 57 000 patients who were
hospitalised for nosebleeds between 2008 and 2010. In all cases reviewed, the
nosebleed had occurred spontaneously and for no apparent reason, Villwock said.
About 4.7% of patients
underwent arterial ligation, a surgical procedure that ties off a blood vessel.
Another 3.4% underwent embolisation, in which a catheter delivers a sealant
that closes off the bad blood vessel.
These treatments are both
riskier and pricier, the researchers said. Embolisation carries a five times
greater risk of stroke than nasal packing, with 1.5% of people who underwent
that procedure suffering a stroke. About 1.3% of people died while undergoing
arterial ligation, a mortality rate nearly twice as high as that of nasal
At the same time, people
receiving embolisation paid an average nearly $66 000 for their hospital stay,
more than three times the amount charged to people treated with nasal packing.
Despite this, embolisation patients had average hospital stays about as long as
people receiving other types of treatment for nosebleeds.
Although the study found an
association between embolisation treatment for nosebleed and an increased risk
of stroke compared to other treatments, it did not establish a cause-and-effect
Dr Richard Rosenfeld,
chairman of otolaryngology with the SUNY Downstate Medical Centre in New York
City, praised the study. "This is the best sort of rocket fuel for
evidence-based decisions and shared decision-making for treating [nosebleeds].
If I were a patient going into the hospital, I'd want to know these numbers. It
could tip a little bit the way people make treatment decisions."
Of the hospitalised
patients in the study, "these people are sick, sick pups. They have a lot
of [other existing health conditions]," Rosenfeld said, including high
blood pressure, alcoholism, kidney failure and lymphoma. "These data might
not apply to the average healthy patient who comes in with a really bad
Rosenfeld said invasive
treatments, although more risky, still were incredibly safe.
"Even for the most
invasive treatments, most people did very well," he said. "Very few
of them had poor outcomes."
Most people can handle
their own nosebleeds by keeping their head parallel to the ground and applying
a little ice and pressure, Villwock said.
"The rule is, if it
hasn't stopped within 20 minutes, it's time to come in," she said.
To learn more about
nosebleeds, visit the US
National Library of Medicine.
Picture: Nosebleed from Shutterstock