What is epistaxis?
Epistaxis is bleeding from the nose, either from one side or both the sides it can pour out from the nose or trickle back into the throat confusing the patient as to the origin of the bleeding. Epistaxis is one of the common emergencies in ENT clinics that has to be promptly handled, it is encountered in our daily practice with patients ranging from infants to people well into their old age.
Why does it happen?
Our nose is our foremost protector and defender from all the micro-organisms and minute particles that are found in our natural environment. The nose is tasked with filtering, moistening, and temperature control of all the air our body and mind need to function on a day-to-day basis which is no easy task. Given the burden, our noses are also richly provided by blood vessels which provide enough blood and oxygen for it to function optimally, the surface of the nose is lined by a very thin mucus membrane which is very easy to break making it a highly vascular and sensitive area.
Causes of epistaxis.
- ADENOIDS – A dysfunctional nose due to enlarged adenoids are the most common cause of nasal bleeds in children, along with addressing the active bleed treating the underlying cause is imperative to stop any future episodes.
- HYPERTENSION
- The rich blood supply of the nose makes it a very favorable location for blood vessels to give away and attempt to reduce the pressure over the vascular system in uncontrolled, poorly managed, and undiagnosed patients with hypertension.
- DNS
- The nose is made up of multiple bones which join together to form a solid functional nose, if the fusion between the bones is at odd angles then it will create an obstruction and friction which in turn will break the delicate mucosa and cause bleeding.
- ALCOHOLISM – Chronic alcoholism will cause nasal bleeds.
- TUMORS –
- Nasal tumors are uncommon and have been known to cause nasal bleeds
- Examples – juvenile nasopharyngeal angiofibroma, inverted papilloma, rhinoscleroma, etc.
- SYSTEMIC DISORDERS
- Autoimmune bleeding disorders can also cause bleeding from the nose.
- TRAUMA
- Any form of trauma to the exterior of the nose or the interior aspects will cause bleeding. The amount of bleeding will depend upon the severity of the injury and the location of the trauma.
- Examples – falling down over the nose, fingernail picking, road traffic accidents, punch to the nose.
Investigations required.
The doctor starts off with a proper history and thorough examination Endoscopy of the nose is performed to identify the location or source of the bleed. Blood investigations to rule out any other associated illnesses. Scan of the nose either a CT scan or an MRI of the nose might be necessary.
Treatment options.
Management of epistaxis will depend upon the underlying cause, the most commonly used treatments are
- Medical management – giving oral or intravenous medicines to help reduce the bleeding.
- Nasal packing – the nose is packed with a gauze or sponge to apply pressure and stop the bleeding.
- Nasal cauterization – the source of the bleeding is identified and cauterized.
The treatment for every patient will vary and it will be a call made by the doctor taking into consideration all the parameters involved.
How to handle it at home.
If you or you’re loved one ever encounters a nasal bleed the first thing to do is not to panic, panic will evidently make the situation tough to handle and also might increase the severity of the bleed.
The first thing to remember would be to lean ahead and drop the head forwards to let the blood flow out of the nose and avoid it from trickling back into the throat or stomach.
Apply strong constant pressure over the nose by firmly pinching it between two fingers.
Along with pressure apply ice packs over the nose and the nape of the neck.
Despite all the efforts at home if the bleeding persists they immediately shift the patient to an emergency or an ENT practitioner.
If the bleeding subsides within 10 to 15 mins, encourage the patient to accept only a soft and cold diet and make an appointment with an ENT clinic near me at the earliest convenience to zero down on the cause of bleeding.
