How to manage epistaxis (nosebleeds) caused by dry air?

Management of Nosebleeds from Dry Air

For nosebleeds caused by dry air, apply firm sustained compression to the soft lower part of the nose for at least 5 minutes, and prevent recurrence by using nasal saline gel or petroleum jelly 1-3 times daily combined with bedroom humidification. 1, 2

Immediate Treatment of Active Bleeding

Proper nasal compression is the first-line treatment and stops the majority of nosebleeds without any other intervention. 1, 2

• Sit upright and lean your head slightly forward to prevent blood from entering the airway or stomach 3
• Apply firm, sustained compression to the lower third (soft part) of the nose for at least 5 minutes continuously without releasing pressure 1, 2
• If bleeding continues after 5 minutes, maintain compression for a full 15 minutes 2
• Breathe through your mouth and spit out any blood rather than swallowing it 3, 4

If bleeding persists after proper compression, apply a topical vasoconstrictor followed by continued compression. 1, 2

• Spray oxymetazoline (Afrin) or phenylephrine 2 times in the bleeding nostril, then continue holding pressure for another 5 minutes 1, 3
• These vasoconstrictors resolve 65-75% of nosebleeds when combined with compression 1

Prevention of Recurrent Episodes

The American Academy of Otolaryngology-Head and Neck Surgery recommends nasal moisturization and humidification as essential preventive measures for dry air-related nosebleeds. 2

Daily Moisturization

• Apply petroleum jelly (Vaseline) or saline gel inside the nostrils 1-3 times daily 3, 1
• Use saline nasal spray regularly to keep the nasal mucosa moist 2, 4
• Continue nasal moisturization even after bleeding has resolved to prevent recurrence 2

Environmental Humidity Control

• Run a humidifier in the bedroom, particularly during winter months or in dry climates 2, 3
• Maintain adequate indoor humidity levels to prevent nasal mucosal dryness 2

Behavioral Modifications

• Avoid nose picking and keep fingernails trimmed 2
• Avoid forceful nose blowing, especially during respiratory infections 3
• Teach proper, gentle nose-blowing techniques 2

When to Seek Medical Attention

Seek immediate emergency evaluation if bleeding continues despite 15-30 minutes of proper compression. 3

• Nosebleeds lasting longer than 20 minutes despite proper compression require medical attention 2
• Seek care if you experience lightheadedness, weakness, or feel faint 3
• Recurrent nosebleeds (more than once weekly) despite preventative measures should prompt medical evaluation 2
• Severe blood loss (filling a cup or more) requires emergency care 3

Common Pitfalls to Avoid

• Do not place tissues or cotton inside the nose as they can be aspirated 2
• Insufficient compression time is the most common error—maintain pressure for at least 10-15 minutes without checking if bleeding has stopped 4
• Avoid bilateral cautery if medical intervention becomes necessary, as this increases risk of septal perforation 1
• After any nosebleed episode, avoid nose blowing, strenuous activity, and heavy lifting for at least a week 2

Advanced Treatment Options (If Conservative Measures Fail)

If bleeding cannot be controlled with compression and vasoconstrictors, medical evaluation may reveal an identifiable anterior bleeding site amenable to cautery. 1

• Nasal cautery can be performed with either chemicals or electricity under local anesthesia 1
• Resorbable packing materials may be used if packing becomes necessary 3
• Endoscopic evaluation and arterial ligation are reserved for refractory cases 1