Frequent nose bleeds

Question: Is it normal for the nose to bleed often? Is it a tell-tale sign of something serious?

Answer: It depends on whether this occurs in children or adults. Nose bleeds may be quite common in children and may not be very serious but is certainly not normal. The commonest cause for nose bleeds in children are from prominent vessels at the front of the nose on the nasal septum in the middle of the nose. This area is called Little’s area and is an area where the various blood vessels of the nose meet. Trauma to this area, either from frequent violent sneezing or nose picking can cause rupture of these vessels, resulting in bleeding. There is often underlying allergy which explains the sneezing and crusting around the nostrils, which in turn results in frequent nose picking. Allergies are more common in children and children tend to be less socially inhibited when it comes to nose picking, hence nose bleeds occur more commonly in childhood.

In adults, nose bleeds can be due to the same problem, especially if there is a history of childhood nasal allergies and bleeding. We are however more worried if bleeding only started recently. It is therefore important to exclude more serious problems, especially tumours in the nose. These could be benign or worse still malignant or cancerous, and can unfortunately occur in children as well. In young teenage boys, a benign tumour known as angiofibroma is common, especially in the West. “Angio” means “blood vessel” and these are very vascular tumours which bleed easily. While cancers are generally uncommon in the young, nasopharyngeal cancer (NPC) can unfortunately occur even in children. Most call NPC a nose cancer but it is really at the back of the nose and is the upper part of the throat or pharynx. It is rare among Caucasians and Indians but is common among Chinese, especially Cantonese and those of Southern Chinese descent. In young Chinese male from 25 to 45 years of age, it is in fact the number one cancer in Singapore. It has been diagnosed in teenagers and rarely, even among pre-teens. As all cancers are generally more vascular, nose bleeds can be a presentation, although it is more commonly blood-stained nasal discharge or phlegm..

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