Nosebleeds: A transient problem that can be brushed off or an indication of another illness? Many people worry when the nose becomes a sudden “tap” and few or many drops of blood start flowing out. “In almost all cases,  it is a problem related to the fragility of the capillaries present in the front of the nose” – said Dr. Luca Malvezzi , specialist of the Unit of Otolaryngology in Humanitas. The blood flow will stop by simply bending the head forward and closing the nostrils with your fingers. In rare cases, it can be a sign of malformations or other diseases, however apart from these cases, it should be underestimated.”


What to do when bleeding from the nose happens often

It is advised to always report frequent and close episodes of nosebleeds to an otolaryngologist. In fact, only a specialist can properly assess whether it is a predisposition often occurring in children (bleeding diathesis) or of a different problem. The specialist will then decide how to take appropriate action.


“We must establish the repeatability of the phenomenon, the patient’s age and condition, and whether nosebleeds are a common problem among other family members -says Dr. Malvezzi. Once the more serious cases are discarded, you can proceed on different paths. In most cases, it will be sufficient to take measures to reduce the vulnerability of the capillaries, by avoiding for example, excessively dry environments, pausing domestic chores, or seeing a doctor if the mucosa is dry or cracked. The patient will be advised to apply emollient creams regularly to the inner walls of the nostrils in order to restore suitable protection to the capillaries. Only when necessary, action is taken by cauterization, which uses heat to weaken the varicose veins in order to stop the bleeding.”



Can bleeding from the nose indicate a dangerous condition?

It is important to be aware when the specialist identifies characteristics apart from simple capillary fragility. “There are conditions in which bleeding from the nose or nosebleeds are very abundant and repetitive. The cause may be due to generally inherited congenital malformations, such as telangiectasia, (Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu syndrome, which is characterized by small arteriovenous malformations that expose continuous bleeding – says Dr. Malvezzi – . An otolaryngologist is the first step towards understanding which path to undergo by thorough diagnosis that will detect the problem from a genetic point of view and further more towards looking for other more serious malformations that can affect vital organs such as the brain, liver, and lungs. In this case, the specialist will know not to cauterize the varicose vein – explains the specialist – but rather send the patient to specialized centers for disease management. The same happens if you suspect the presence of a tumor in the nasal area and paranasal sinuses, which require radiological investigations. ”

Other cases, although even more rare, involve larger blood vessels such as the sphenopalatine artery. Finally, keep in mind that even medications can cause bleeding from the nose. “Adults and elderly patients who are taking anticoagulants or antiplatelet drugs – says Dr. Malvezzi – are naturally more susceptible to rhinoplasty if their mucosa shows signs of vulnerability due to aging.”




Dr. Luke Malvezzi

ENT specialist of Humanitas