NOSEBLEEDS (EPISTAXIS)

A nosebleed (epistaxis) is the relatively common occurrence of bleeding from the nose, usually noticed when it drains out through the nostrils.

There are two types of nose bleed:

- anterior (the most common), and
- posterior (less common, more severe).

All nosebleeds are due to tears in the mucosal lining and the many small blood vessels it contains. Fragility or injury may cause the tears, while inflammation, coagulation problems and other disorders may make the injury harder to repair.

Causes

Local factors

• Anatomic deformities
• Chemical inhalant
• Inflammatory reaction (eg. acute respiratory tract infections, chronic sinusitis, allergic rhinitis and environmental irritants)
• Foreign bodies
• Intranasal tumours (Nasopharyngeal carcinoma in adult, and juvenile angiofibroma in adolescent males)
• Nasal prong O2 (continuous positive airway pressure therapy)
• Nasal spray
• Surgery (such as septoplasty and endoscopic sinus surgery)
• Trauma

Systemic factors

• Drugs - aspirin, warfarin, clopidogrel, desmopressin and others
• Alcohol (due to vasodilation)
• Allergies
• Blood dyscrasias
• Heart failure (due to an increase in venous pressure)
• Hematological malignancy
• Hypertension
• Infectious diseases
• Malnutrition (especially anemia)
• Narcotics
• Vascular disorders
• Muscle tightness as caused by scoliosis (the tightened muscles cause blood vessels to be come constricted, resulting in nosebleeds from the same side as the tightened muscles).

Treatment

The flow of blood normally stops when the blood clots, which may be encouraged by direct pressure and reducing the blood pressure in the head by sitting upright with the head tilted forward for about 10 minutes. Tilting the head back is not advised, as it can lead to blood flowing into the respiratory system, and possibly resulting in death or vomiting. Petroleum jelly is sometimes applied to stop the blood from seeping out of and prohibit the loss of moisture in the nasal cavity. However, the jelly can drain into the lungs producing a buildup that leads to lipoid pneumonia.

If other techniques do not work, an anterior packing is a possible remedy. An anterior pack works by applying pressure from the inside of the cavity, thus stopping the bleeding. This procedure can be performed at home for minor nosebleeds by gently packing tissue or gauze into the nasal cavity. Nasal sponges are readily available at most drugstores and supermarkets.

If bleeding continues, seeking emergency medical attention is important. Continued bleeding is an indication of more serious underlying conditions.[3] First aid includes inserting either a balloon inflated nasal tampon or dry hydrophilic nasal tampon.

Chronic epistaxis resulting from a dry nasal mucosa is often treated by spraying saline in the nose up to three times per day. There are also non-petroleum based gels that can be used.

Persistent epistaxis is an indication for urgent medical consultation. Nasal packing, cryosurgery, electrocautery or application of trichloroacetic acid are options that may be used in severe epistaxis.

It is uncommon to die from bleeding through nosebleeds. However, damage to the maxillary artery can lead to rapid blood loss via the nose and present difficulty in treatment, pressure, vasoconstrictor and rhinocort occasionally proving ineffective. Embolization or ligation of the artery, risking damage to the facial nerves, may be the only solution.

Nevertheless, severe protracted nosebleeds may cause anaemia due to iron deficiency.

If a nosebleed lasts for more than 15 minutes, occurs following a serious injury, or is accompanied by severe blood loss, you should call your doctor or go to the emergency room.