Nosebleed Treatment in Sydney (Epistaxis)

Epistaxis, or nosebleed, is bleeding from the blood vessels inside the nose. While most nosebleeds are minor and stop on their own, recurrent or severe nosebleeds can significantly affect quality of life and may indicate an underlying condition requiring specialist treatment. At Central Sydney ENT, our FRACS-qualified surgeons provide clinic-based cautery and surgical management for all types of nosebleeds in adults and children.

Types of Nosebleeds

Anterior nosebleeds: The most common type, accounting for over 90% of cases. Bleeding originates from Little's area (Kiesselbach's plexus) on the front part of the nasal septum, where several small blood vessels converge. These are usually manageable with first aid and cautery.

Posterior nosebleeds: Less common but more serious. Bleeding comes from larger vessels deeper in the nose, often the sphenopalatine artery or its branches. Posterior bleeds are more difficult to control and more common in older adults, particularly those on blood-thinning medications.

Common Causes

Nasal dryness and crusting, particularly in dry or air-conditioned environments
Nose picking or digital trauma (especially common in children)
Blood-thinning medications including aspirin, warfarin, clopidogrel, and DOACs (rivaroxaban, apixaban)
High blood pressure (hypertension)
Deviated nasal septum with exposed blood vessels
Nasal sprays including corticosteroid sprays and decongestants
Upper respiratory tract infections and allergic rhinitis
Hereditary haemorrhagic telangiectasia (HHT/Osler-Weber-Rendu syndrome)
Nasal tumours or polyps (uncommon but important to exclude)
Bleeding disorders or liver disease

Diagnosis

Your ENT specialist will assess the cause and source of your nosebleeds through:

Nasal endoscopy: A thin camera is used to examine the inside of the nose, identify the bleeding point, and check for polyps, tumours, or other structural abnormalities.

Blood tests: A full blood count, coagulation profile, and assessment of liver and kidney function may be requested, particularly if you are on blood thinners or have frequent bleeds.

CT scan: Imaging may be ordered if a structural cause, tumour, or vascular malformation is suspected.

Blood pressure assessment: Poorly controlled hypertension is a significant contributor to recurrent and severe nosebleeds.

Treatment Options

First aid: Sit upright, lean slightly forward, and pinch the soft part of the nose firmly for 15 to 20 minutes. Do not tilt the head back. Apply an ice pack to the bridge of the nose. Seek medical attention if bleeding does not stop.

Nasal cautery: The most common clinic procedure for recurrent anterior nosebleeds. Silver nitrate chemical cautery or electrocautery is applied to the visible bleeding vessel on the septum under local anaesthetic. The procedure takes a few minutes and is very effective.

Nasal packing: For active bleeding that cannot be immediately cauterised, dissolvable or removable nasal packs are placed to apply pressure to the bleeding site. This is typically performed in hospital emergency departments.

Sphenopalatine artery ligation: For severe or recurrent posterior nosebleeds, the sphenopalatine artery can be clipped or cauterised endoscopically under general anaesthetic. This is a highly effective definitive procedure.

Embolisation: In rare cases, interventional radiologists can block the bleeding vessel from the inside using a catheter threaded through the groin artery.

Medical management: Addressing contributing factors such as blood pressure control, medication review, nasal moisturising with saline sprays, and topical antiseptic creams to reduce crusting and scab formation.

When to See an ENT Specialist

Nosebleeds occurring more than once a week
Nosebleeds lasting longer than 20 minutes despite correct first aid
Heavy nosebleeds requiring emergency department presentation
Nosebleeds in a patient taking anticoagulant medication
One-sided nosebleeds associated with nasal obstruction (to exclude a tumour)
Recurrent nosebleeds in children affecting school attendance or activities

Our Specialists

Nosebleed assessment and management at Central Sydney ENT is provided by all six of our FRACS-qualified ENT surgeons, including rhinology specialists Dr Arjuna Ananda, Dr Rahuram Sivasubramaniam, and Dr Jareen Ebenezer. Clinic cautery appointments are available at our Burwood main practice and satellite locations.

Related conditions: Nasal Fractures • CSF Leak

Related procedures: Sinus & Nasal Surgery

Frequently Asked Questions

When should I see an ENT specialist for nosebleeds? +

See an ENT specialist if you have nosebleeds that occur more than once a week, last longer than 20 minutes despite correct first aid, require emergency department visits, are associated with blood-thinning medications, or occur in only one nostril with associated nasal blockage.

What causes frequent nosebleeds in adults? +

Common causes include nasal dryness and crusting, nose picking, blood-thinning medications (aspirin, warfarin, newer anticoagulants), high blood pressure, deviated septum, and nasal sprays. Less common causes include hereditary haemorrhagic telangiectasia (HHT) and nasal tumours.

What does nasal cautery involve? +

Nasal cautery is a quick procedure performed in the clinic under local anaesthetic. The ENT specialist uses silver nitrate or electrocautery to seal the bleeding blood vessel on the nasal septum. It takes only a few minutes and most patients can go home immediately afterward.

How do I stop a nosebleed at home? +

Sit upright and lean slightly forward. Pinch the soft part of your nose firmly with your thumb and index finger for 15 to 20 minutes without releasing. Breathe through your mouth. Do not tilt your head back, as this causes blood to run down your throat. If bleeding does not stop after 20 minutes, seek medical attention.

Can children get nosebleeds cauterised? +

Yes, nasal cautery can be performed on children, though younger children may require a brief general anaesthetic. For older cooperative children, it can often be done in the clinic with topical anaesthetic. Cautery is very effective for recurrent anterior nosebleeds in children.