The Medical Consumer's Advocate
Chronic nose bleeds
Q:
I have
been having nose bleeds for years now. I've been to a
specialist and he told me that I have a sensitive area
where the air must pass through and when that gets dry I
bleed. I am concerned about this bleeding and I'm not
quite sure how to deal with it since I react very badly
to sprays in my nose. Are there any special indications
that could determine if I have a tumor in my nose? What
are some of the signs I should look for so that I can
alert my doctor? He never talked to me about the
possibility of a tumor. Another thing, I have problems
with allergies and I've noticed that after a severe
attack and especially if it comes with clogged sinuses
then I bleed rather profusely afterwards. What can I do
to reduce my incidences of bleeding which sometimes last
close to an hour?
[Note added in 2005: I'm afraid this response was not . . . erm . . .
terribly responsive. The questioner specifically asks what signs would
indicate the presence of a tumor -- an excellent question which I proceeded
to ignore.
A: If you have been having nose bleeds "for years,"
chances are heavily in your favor that you do not have a tumor. (Any tumor
destructive enough to cause bleeding would have caused more ominous
problems by now.) Nevertheless, anything is possible, so if
you do not respond well to "conservative
management" your doctor needs to look further for an
explanation. In addition to tumors, I would worry about arteriovenous malformations and aneurysms. By "look
further," I mean that your doctor should at the very
least examine your nose with a rigid or flexible endoscope,
in order to examine the entire nasal cavity. If he/she is
still suspicious of a problem, a CT (or, occasionally, an
MRI) would be the next step. Generally speaking, an ENT is
the right individual for this investigation.
If you have not already done so,
take a look at my page on nose bleed precautions. This will tell you how to conservatively
treat (and prevent) your nosebleeds. Also listed on this page
are the warning signs for a nasal tumor.
If, after 2 to 4 weeks of
conservative management, you are still having nosebleeds,
then your doctor needs to be more aggressive (as described
above). Referral to an ENT at that point is essential.