My-ENT

Condition

ENT consultation for recurrent nosebleeds at My-ENT Sydney.

Nosebleeds

Clinical term: Epistaxis

Most nosebleeds (epistaxis) are brief and settle without specialist care. When bleeding is frequent, heavy, or not responding to simple first aid, ENT review can identify the underlying cause and guide appropriate management. In most cases, a clear explanation is found and a practical plan can be put in place.

Symptoms

What patients often notice

  • Bleeding from one or both nostrils, either spontaneous or triggered by nose blowing or minor contact.
  • Bleeding that takes longer than 15 to 20 minutes to settle with sustained direct pressure.
  • Recurrent episodes occurring several times per week or month.
  • Heavier bleeding than expected, or bleeding that is difficult to control at home.
  • Associated nasal blockage, crusting, or structural symptoms that suggest an underlying cause.

Causes

Why this can happen

Dry air or low humidity making the nasal lining fragile and prone to minor bleeding.

Nose picking, particularly in children - the most common direct cause of nosebleeds in younger patients.

Hayfever, sinus infections, or other nasal inflammation increasing the fragility of nasal blood vessels.

Blood-thinning medications including aspirin, warfarin, and newer anticoagulants making nosebleeds harder to stop once started.

Less commonly, a bleeding disorder or vascular abnormality such as hereditary haemorrhagic telangiectasia - relevant when nosebleeds are recurrent, heavy, or difficult to control.

Tunkel DE et al. Clinical Practice Guideline: Nosebleed (Epistaxis). Otolaryngol Head Neck Surg. 2020;162(1 Suppl):S1-S38.

When to seek help

When to arrange review

Arrange specialist review for frequent or heavy nosebleeds, bleeding that does not settle with sustained direct pressure applied for 15 to 20 minutes, or nosebleeds occurring alongside other nasal symptoms such as blockage or crusting. Patients on anticoagulant or antiplatelet therapy with recurrent epistaxis should be reviewed early.

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Treatment

Treatment overview

Assessment typically includes a nasendoscopy to examine the nasal lining and identify any obvious bleeding point, polyp, or other findings. Management depends on the cause and may include nasal cauterisation to treat a visible bleeding vessel, targeted treatment of an underlying inflammatory or structural condition, or coordination with the treating physician where medications are contributing to bleeding frequency.

Choosing your surgeon

Choosing your surgeon

Choosing the right specialist takes thought. Fellowship training, experience with the relevant condition, and contribution to teaching and research are all meaningful indicators. A public appointment at a tertiary hospital is another recognised marker of professional standing. Online reviews can be helpful, but they don't tell the whole story.