Nasal bleed | 5 avoidable causes in young & middle-aged adults

Avoidable causes for nasal bleed in young and middle-aged adults are listed below. This article is the second part of a three-part series.

1. Abuse of prescription drugs:

Nasal bleed is frequently seen in patients who abuse antihistamines(anti-allergy medicines) and nasal decongestants(medicines for nose block) excessively without proper medical diagnosis or advice. These medicines are easily available at the local pharmacy level despite strict Indian Pharmacy Laws. These drugs have a tendency to dry out the nasal mucosa which is more prone to injury, hence, the nasal bleed. Unadvised use of aspirin is another reason for a nosebleed. It is a blood thinner that prevents the blood from clotting by affecting the platelets. Any small injury in patients who take aspirin tends to bleed longer than usual.

2. Recreational drugs:

Nose bleeds are due to chemical injuries to the Little’s area on the septal mucosa. Drugs used by snorting are usually suspected (Example: Cocaine). These drugs cause vasoconstriction followed by a lack of blood to the nasal mucosa which then necroses. This leads to the development of septal perforation and bleeding from the wound edges.

3. Exposure to extreme temperatures:

Exposure to dry and hot weather conditions or extremely cold conditions have a drying effect on the nasal mucosa, which tends to crack and bleed. Humidification, adequate water intake and saline nasal washes/sprays, wearing a cloth mask can help keep the mucosa moisturised and prevent nasal bleeding.

4. Allergic rhinitis, vasomotor rhinitis and sinusitis:

Repeated sneezing, blowing the nose forcefully in an attempt to clear mucous ruptures the blood vessels of the nose, causing nasal bleeding. For the resolution of the nosebleed, the cause is identified and treated.

5. Trauma:

Bar fights and road traffic accidents are common in this age group as a cause of trauma to the nose. The nose is a frequent target as it is the most prominent & protruding feature of the face. Nasal bone fractures and soft tissue injuries present with nasal bleeding. 

In young and middle-aged adults most of the causes are avoidable. This isn’t a comprehensive list of reasons for epistaxis(nosebleed). Tumours & bleeding disorders can cause nosebleeds in all age groups but are less frequently diagnosed in this group, hence they have not been mentioned here. Pregnancy-associated hyperemia of the nose is another cause of nose bleed in women of this age.

This article was written by Dr Akanksha Saxena, Consultant ENT, Head & Neck Surgeon, ENT360. She is a practising ENT Specialist in Gurgaon with over 10 years of experience. Read more of her blogs here.