www.eentdisorder.com - EENT Disorder

Epistaxis 

Below:

• What is epistaxis?
• Causes
• What happens during epistaxis?
• Treatment
• Posterior epistaxis

What is epistaxis?

Epistaxis is defined as bleeding from the nostrils, nasal cavity or nasopharynx. It is a common problem and occurs most frequently in children under 10 years of age. After childhood, the incidence decreases with age. Epistaxis can sometimes be frightening for patients but few cases require medical attention and even fewer require hospital admission.

Causes

There are many reasons for nose bleeding but the most common are nasal congestion (from respiratory tract infections), nose ‘picking’ and injury to the nasal area.

The nose has a very rich blood supply and the mucosa (thin skin) covering the inside is very fragile, thus any stress to the area can easily result in bleeding.

Epistaxis is more common in the colder seasons and can occur spontaneously when the nasal membranes become dry and crack during the winter months, when humidity is lower and domestic heating produces dry, warm air.

Rarely, a bleeding nose may be a sign of an underlying condition such as pregnancy, high blood pressure, blood diseases, abnormal blood vessels, or a tumour of the nose or sinuses. The use of particular medications, especially aspirin, warfarin and non-steroidal anti-inflammatory drugs (NSAIDs), can also cause epistaxis.

What happens during epistaxis?

Bleeding may occur from one or both nostrils and is medically defined according to the blood vessels from which the bleeding originates. Some 90% of nosebleeds start in the anterior nasal blood vessels and only 10% in the posterior vessels. In most cases blood loss will not be sufficient to cause symptoms but, if severe, may result in weakness, dizziness, or nausea.

The vast majority of spontaneous or traumatic nosebleeds in an otherwise healthy individual stop within five minutes. This may be helped by pinching the nostrils against the septum (the bone and cartilage that separates the two airways and the nostrils), pressure to the upper lip, or a cold compress and pressure to the bridge of the nose. If possible, lean forward and keep the mouth open in order to avoid swallowing any blood.

If the bleeding continues, is recurrent, if there is a lot of blood loss, or you have symptoms of blood loss, it is important to seek medical attention.

Treatment

The aims of treatment are to control bleeding as quickly and effectively as possible, to isolate a cause and to avoid a recurrence. After taking a brief history from you, your doctor will carefully examine your nose to isolate the bleeding vessel, if possible. This may require the use of a nasal speculum, a small device to spread the sides of the nostrils allowing a better view of the mucosa.

If manual nasal compression fails your doctor may stop the bleeding using cautery or nasal packing. Cautery involves sealing the leaking blood vessel using heat (electrical cautery) or chemicals (chemical cautery). Nasal packing involves the insertion of foam or gauze into the nasal cavity to form a tight seal, compressing the leaking blood vessel and encouraging clot formation. Packs are usually kept in place for two to five days and during this time you may be prescribed antibiotics and painkillers.

After treatment, it is advisable to rest and avoid vigorous exercise for several days, avoid blowing the nose, closed mouth sneezing or inserting anything into the nostrils. If possible, keep the nasal membranes moist with ointment, saline or Vaseline.

Posterior epistaxis

Posterior epistaxis is rare in children and accounts for approximately 10% of all cases. It is generally more difficult to control and requires a special nasal pack or inflatable nasal balloon and subsequent referral to an ear, nose and throat (ENT) specialist. Complications are rare and include infection, sinusitis, septal haematoma (blood clot) and external nasal deformity.
In addition to specific treatment of the bleeding, it is important to try to identify a cause. This may be done by taking a detailed personal and family history, including previous illnesses and medications. Blood pressure should be checked and, if necessary, blood samples taken to test for abnormal blood clotting and blood cell counts.

Severe symptomatic epistaxis requires urgent medical treatment, which is dependent on the cause and extent of the blood loss. Overall, the prognosis for epistaxis is excellent even for those cases requiring medical intervention.