Understanding nosebleeds

Nosebleeds are unpleasant, and happen for a number of reasons. Most nosebleeds are relatively harmless, although very rarely they may be a symptom of something more serious. In most cases, simple preventative steps can be taken to try and reduce their frequency. In order to establish whether or not you should seek medical attention, it is helpful to understand why nosebleeds occur.

There are two broad types of nosebleed:

1. Anterior – this means the bleeding has started towards the front of your nose
2. Posterior – these are less common and start at the back of your nose

What causes anterior nosebleeds?

Anterior nosebleeds are more common, and are rarely a cause for concern. They result from the delicate blood vessels near the entrance to your nose bursting.

This may be due to physical causes, such as an injury or bump to the nose; blowing your nose very hard; inserting fingers into the nose (a common problem in small children) or nasal complaints such as a cold or sinusitis.

Environmental factors can also cause anterior nosebleeds. These include allergies such as hay fever; changes in altitude; rapid changes of air temperature; dry air or overuse of over-the-counter decongestant sprays.

Anterior nosebleeds are generally self-limiting.

More serious conditions

Posterior nosebleeds can be more serious. The blood is coming from larger arteries, located further back in the nose. Therefore, the flow can be harder to control. The blood is also more likely to run into the throat.

These nosebleeds can result from head or facial injury. Very rarely, they may be symptomatic of nasal tumours. Some people are more prone to this type of nosebleed.

Both anterior and posterior nosebleeds can be exacerbated by certain types of medicine, such as those prescribed for blood thinning (for example, aspirin or warfarin). Some herbal medicines, such as gingko biloba, can also increase the risk of bleeding.

People suffering from high blood pressure may have an increased susceptibility to nosebleeds. Nasal problems such as a bend in the middle partition of the nose (septal deviation) or chronic rhinitis or sinusitis also leave people more vulnerable to nosebleeds.

When to seek medical advice

Nosebleeds are rarely serious, and it is important to stay calm. You can apply pressure to the middle partition at the front of the nose by pinching the nostrils, and most nosebleeds will stop of their own accord. If you think you may be suffering from one of the more serious types of nosebleed, or you have been experiencing blood flow for more than 20 minutes, it is sensible to seek medical attention.

If you are experiencing frequent nosebleeds you may be referred to an ENT surgeon. Consultant ENT surgeon Mr Julian Hamann can investigate and treat nosebleeds. Treatment is often simply a matter of cauterising the ‘bleeding point’ in the nose, sealing it to prevent recurrence of the problem.

Could snoring increase your risk of developing dementia?

Snoring is a common problem; the NHS estimates that one in four people in England snore and the risk increases as you get older. But before you dismiss this pesky habit as just an annoyance, snoring is increasingly being linked to a number of very serious medical problems including dementia.

Earlier this year, Time magazine published the results of a study that found that any disruption to sleep patterns can affect the brain over time. Initially published in the journal Neurology, the study found that people with sleep apnoea, which is commonly associated with snoring, tend to develop memory problems and other symptoms of mild cognitive impairment at an earlier age than those that don't snore or suffer from sleep apnoea.

The link between snoring and dementia

Researchers at the NYU Center for Brain Health followed 2,000 patients enrolled in the Alzheimer's Disease Neuroimaging Initiative. These patients – all over the age of 55 – were asked about their snoring or sleep apnoea and their cognitive status was assessed every six months for three years and any changes were recorded.

It was found that snorers or those suffering from sleep apnoea developed sings of mild cognitive impairment about 12 years earlier than those not suffering from sleeping disorders. Mild cognitive impairment is often the precursor for developing Alzheimer's.

The reason why these sleep disorders might be causing these problems is not entirely clear. It's possible that even the short periods where breathing is interrupted starves the brain of oxygen. Other studies have indicated that levels of amyloid, the protein responsible for Alzheimer's, build up during the day and decrease at night.

Snoring and other health problems

It's not just an increased risk of developing dementia; sleep disorders have been linked to a number of other serious health concerns:

• stroke – if you're a particularly loud snorer then you have a greater risk of carotid atherosclerosis, the narrowing of arteries in the neck, that can lead to stroke

• heart disease – studies have shown that those suffering from sleep apnoea are two times more likely to have a heart attack

• Gastroesophageal reflux disease, or GORD, is a common associated health problem for those who suffer from sleep apnoea – although it's not completely clear why this happens.

If you're worried that snoring or sleep apnoea is becoming a problem, then there are a number treatment options that can be explored. Book a consultation with ENT consultant surgeon Mr Julian Hamann to discuss your treatment options in full.