Trends for Treating a Bleeding Nose

Epistaxis was commonly treated with nasal packing embolization or cauterization

(RxWiki News) While it may be difficult to know when and where a nosebleed will happen, treatment options are much easier to determine.  

A recent study found that common medical treatments for nosebleeds included nasal packing, embolization and cauterization.

Nasal packing is the use of cotton packs or gauze to stop the bleeding. Embolization involves blocking the blood vessel that is responsible for the nosebleed, and cauterization involves burning the affected area to stop the bleeding. 

According to the authors of this study, about 60 percent of the population will have at least one nosebleed during their lifetime, but only 6 percent of all nosebleeds will require medical attention.

Having a nosebleed that won't stop is a sign that medical attention is needed.

"Seek medical attention if you have a nosebleed that persists."

This study was led by Jennifer A. Villwock, MD, of the Department of Otolaryngology at State University of New York–Upstate Medical University. The research team examined trends for the treatment of nosebleeds from 2008 to 2010 in the US.

Data was analyzed from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project with the Agency for Healthcare Research and Quality.

Several factors were taken into account that could have affected nosebleed treatment including: age, sex, race, number of chronic conditions, annual patient income, insurance (Medicare, Medicaid, private insurance, self-pay or no charge), hospital region (Northeast, Midwest, South and West), hospital location (urban versus rural) and ownership of hospital (public, private nonprofit and private for profit).

From their sample, the researchers identified a total of 57,039 nosebleed cases that required medical or surgical treatment. The patient sample had an average age of 64.7 years. A total of 47.6 percent of the subjects were female and 53.4 percent were male.

The researchers identified four treatments for nosebleeds in their analysis:

  • Conservative management – observation until bleeding stopped on its own
  • Cauterization of the bleeding site – burning the affected area to stop the bleeding
  • Nasal packing – sticking gauze or cotton packs in the nose to control bleeding
  • Arterial ligation – a surgical technique that involves the binding together of arteries (blood vessels)
  • Embolization – blocking the blood vessel that is responsible for the nosebleed

Of the 57,039 nosebleed cases, about 38 percent were treated with conservative management, about 53 percent received nasal packing or cauterization, approximately 5 percent underwent arterial ligation and about 3 percent underwent embolization.

The researchers also looked at economic costs of treatment and specific clinical outcomes, including blindness, stroke and death.

Patients who underwent an embolization were more than four times more likely to have a stroke than patients who underwent nasal packing.

There was no significant difference found in likelihood of death between groups.

Patients who had an embolization also were found to have the highest total hospital costs — almost twice that of patients who had arterial ligation — despite being in the hospital for a similar amount of time.

The authors noted that their study had some limitations, such as the cases in their sample coming from only 20 percent of US hospitals. Also, some patients received multiple treatments, which made it difficult to determine the effect of each individual treatment on clinical outcomes.

The authors concluded that more research is needed to determine how the different treatment options for a nosebleed affect clinical outcomes.

This study was published on October 17 in JAMA Otolaryngology—Head Neck Surgery.

The authors reported no competing interests.

Review Date: 
October 16, 2013