Are you a rhinotillexomaniac?
In other words, do you pick your nose?
The socially acceptable answer is no, because none of us admits – out loud – to sporadic digital delving.
However, back in 1995, in an American survey published in the Journal of Clinical Psychiatry of 254 Wisconsonites, 91 per cent admitted in a questionnaire that they were "current nosepickers", with 1.2 per cent succumbing at least once an hour. And, in 2001, reporting in the same journal, researchers surveyed 200 adolescents in Bangalore, India, finding not only that the teenagers harvested nasal mucus at a median frequency of four times a day, but also that about 17 per cent "considered that they had a serious nose-picking problem".
It seems reasonable to infer that if the European prevalence of rhinotillexomania hasn't unaccountably plummeted compared to the United States and India, Ireland too has its fair share of nasal adventurers, which prompts a recent memory of a festive celebration when rampant bonhomie demanded repeated sampling from bowls of nuts, crisps and assorted confections into which unwashed fingers and thumbs had been plunged.
But when a partying rhinotillexomaniac takes a break from sifting your macadamias to undertake a digital exploration of the upper reaches of his or her nose, it’s worth remembering that such a leisurely pursuit is freighted with the risk of inducing nose bleeds, or epistaxis.
Hospitalised
Epistaxis is one of the commonest presenting symptoms to ear, nose and throat departments, general practice and emergency departments: each year it affects 12 per cent of the population; an estimated 10 per cent of cases need medical attention; and about 60 per cent of the population have at least one nose bleed in their lifetime.
These facts are cited in a recently published study in the Irish Journal of Medical Science in which Dr Brian Carey and Dr Patrick Sheahan reviewed the cases of 721 patients who attended the South Infirmary Victoria University Hospital, Cork between June 2014 and May 2015. Of the 721 patients, 59 were hospitalised for a mean duration of five nights, and the mean age of hospitalised patients was 66.8 years.
Significantly, 69.5 per cent of the 721 patients had high blood pressure (hypertension), and the Cork researchers highlight an increasing prevalence of hypertension in Ireland, affecting more than 60 per cent of adults over 50 years old.
Although there is disagreement in the medical literature over whether a direct relationship exists between hypertension and nose bleeds, the authors state: “Blood vessels in the nose lie relatively unprotected and superficial under nasal mucosa. It is possible that the pathological mechanism of raised arterial pressure, the same that leads to structural alterations in cerebral and retinal vessels, causes arteriolosclerosis in the nasal vasculature, thus predisposing patients with hypertension to epistaxis.”
The role of aspirin in nose bleeds is inconclusive, with different studies producing conflicting results
Another significant finding in the Cork study was that 78 per cent of the patients used an anti-platelet or anti-coagulation medication: “Such medications include aspirin, clopidogrel, nonsteroidal anti-inflammatory drugs, warfarin and novel oral anticoagulant drugs.”
However, the role of aspirin in nose bleeds is inconclusive, with different studies producing conflicting results.
Distressing
As far as nose bleeds in children is concerned, three studies since 1979 have shown that it is relatively common, occurring in about 30 per cent of children aged 0 to 5 years, and in more than 50 per cent of children over 5 years.
A recent American study in the International Journal of Pediatric Otorhinolaryngology notes that childhood nose bleeds can be distressing for both child and parent. However, it adds, "for most children, epistaxis is spontaneous, self-limited, and often arises from digital trauma or rhinitis involving the anterior nasal septum. These cases of epistaxis are rarely severe, and do not usually require medical intervention or hospital admission."
So what should we do in the event of a nose bleed?
Lead author of the Cork study Dr Brian Carey is a surgical senior house officer at Cork University Hospital. He told The Irish Times: "As regards general advice I would suggest: first, tilt your head forward; apply pressure at the end of your nose with your thumb and index finger; pinch this area and hold it for a minimum of 10 minutes or until the bleeding stops. Placing a cold cloth or small ice pack on the bridge of your nose will also slow blood flow by constricting blood vessels. I would add that people should seek urgent medical treatment if the bleeding continues for more than 20 minutes."
As for less typical causes of nose bleeds, the title of a 2016 report in the Indian Journal of Otolarngology and Head & Neck Surgery says it all.
In “Epistaxis Due to Leech Infestation in Nose: A Report of Six Cases and Review of Literature”, the authors describe how six patients with recurrent nose bleeds presented over a four-year period at a hospital in a hilly area of Darjeeling, India. “Anterior rhinoscopy revealed fleshy greenish brown mobile mass inside the nasal cavity which was removed by forceps. The animate foreign body was identified as leech in all the cases.”
Rhinotillexomania is clearly not the sole risk factor for inducing nose bleeds, but if we can eliminate unnecessary nasal probing it may help reduce the number of visits to hospital emergency departments.