My 11-year-old daughter has been having nosebleeds -- three or four in a week's time every couple of months. The pediatrician says it isn't serious and that he saw shallow vessels in her nose. He called it "Hassell's triangle." He said cauterizing would probably only work for a short time, and that we should concentrate on keeping the inside of her nose moist and using humidifiers. I hate to think that this is just something she will have to live with. It isn't dangerous, but it is nerve-wracking for her, as the nosebleeds can start at any time.

R.H.

I have not heard this area called "Hassell's triangle." The two appellations that I am familiar with are "Kiesselbach's plexus" and "Little's area." If you are searching for relevant information, your best bet would be to use "nosebleed," "nose bleed," and "epistaxis" as search terms. (Epistaxis is the medical term for nosebleed.)

Kiesselbach's plexus, also known as Little's area, is an area on the nasal septum (the bony/cartilaginous partition between the two nasal cavities) that is very close to the nostril. The tissue (mucosa) that covers the septum in this region is particularly prone to trauma. Fingernails are the usual culprits.

As your daughter's pediatrician has correctly pointed out, dryness is also an important factor. This is one of the least-humid areas in the nasal cavity, and the blood vessels are close to the surface. She can improve the situation by using a humidifier in her bedroom and by spraying her nasal cavities frequently with a saline nose spray. (If you have any doubts about what to use, ask your pharmacist to recommend a saline nose spray. DO NOT use any medicated sprays unless instructed to do so by her doctor.) "Frequently" means three or more times per day, and especially at bedtime. After spraying her nasal cavities with saline at night, she can place a very small dab (the size of one-fourth of a pea) of antibiotic ointment onto each Little's area with a clean fingertip or a cotton swab. She can then pinch her nose gently in order to coat each Little's area with the ointment. The idea is exactly the same as when you apply moisturizer to your face after washing your face.

If this does not eliminate the problem, or if your daughter is unable or unwilling to comply with this approach, then she needs to be referred to an ear, nose and throat specialist (ENT). An ENT can confirm the pediatrician's diagnosis. The diagnosis is probably correct, but there are always a variety of explanations for any given problem -- including some rare and unusual conditions -- and that's something a specialist is best suited to examine.

An ENT can also provide other options for treatment. In this regard, I beg to differ with her pediatrician -- cautery can provide much more than just a "short-term fix." Most patients treated this way have lasting relief from their nosebleeds, though several separate treatments may be necessary to achieve a "cure." The ENT can pretreat the area with a topical anesthetic, so that the cautery (typically with a chemical called silver nitrate) is painless.

Finally, there may be an obvious anatomic explanation for your daughter's problem. She may have a severely deviated septum, which would lead to turbulent airflow in one or both nasal cavities and subsequent areas of dryness. She may also have one or more "spurs." Spurs are protuberances caused by an underlying deformity of the bony or cartilaginous skeletal framework of the septum. Spurs, too, can cause turbulent airflow and areas of dryness, making the tissue fragile and leading to frequent nosebleeds. Septal deviation and spurs are surgically correctable problems.

Cautery and surgery are rarely first-line treatment recommendations. Many kids will do fine if encouraged to avoid digital intranasal expeditions (nose-picking) and to frequently use saline sprays. Nevertheless, some patients do require more aggressive intervention.