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EPISTAXIS

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EPISTAXIS

Epistaxis is the common occurrence of bleeding from the blood vessels in the nose.

  • Epistaxis is the medical term for nosebleed.
  • Most nosebleeds are usually mild, not life threatening and can stop on their own or be easily treated.
  • Sometimes bleeding can be persistent and more severe.
  • Nosebleeds occur more often in dry, cold climates and during winter months.
  • Nosebleeds are categorized base on the site where the bleeding originates.
  • They are described as the anterior nosebleeds or posterior nosebleeds.
  • The anterior nosebleeds originate from the front of the nose and make up most nosebleed.
  • Anterior nosebleeds are easy to control and manage.
  • Posterior nosebleeds usually originate from an artery in the back part of the nose and are much less common than anterior nosebleeds.
  • They are more common in elderly people.
  • The bleeding is more complicated and may require admission and management by an otolaryngologist in the hospital.
  • Nosebleeds can occur at any age but are most prevalent among children between ages 2 to 10 and adults between ages 50 to 80.

CAUSES

Nosebleeds are due to a rupture in a blood vessel within the nose. The following predisposes people to nosebleeds:

  • Trauma to the outside of the nose by a blow to the face
  • Nose picking.
  • Nasal and sinus infections.
  • Mucosal irritation.
  • Inflammatory diseases.
  • Allergic rhinitis.
  • Hormonal changes during pregnancy.
  • Vigorous nose blowing.
  • Exposure to warm, dry air for a long period of time.
  • Nasal surgery.
  • High blood pressure may contribute to bleeding.
  • Tumors and inherited bleeding problems are less common causes of nosebleed.
  • Alcohol abuse.
  • Use of blood thinning medications.
  • Presence of a foreign body in the nose.
  • Hole in the nasal septum

SIGN AND SYMPTOMS

The symptom associated with epistaxis is bleeding in the nostril. The bleeding is usually from one nostril. However, in cases of heavy bleeding, blood can overflow into the nasopharynx (the area where the two nostrils meet), causing both nostrils to be bleeding simultaneously.  Heavy bleeding may result in excessive blood loss. Excessive blood loss is mostly accompanied by dizziness, fainting, and weakness.

DIAGNOSIS AND TREATMENT

DIAGNOSIS

Bleeding from the nostril is generally visible upon seeing the patient, though bleeding may be less apparent in some individuals upon arrival to seek medical care. The doctor will need to detect the source of the bleeding and determine whether nosebleed is anterior or posterior. The doctor may require the medical history of such patient to find other less common causes of nosebleed.

  • The doctor may examine the nose by inserting a metallic instrument called a nasal speculum to visualize the inside of the nose. This is useful in identifying the exact site of bleeding
  • In cases of severe nose bleeds, a blood count test may be carried out to assess the degree of blood loss.
TREATMENT
  • A mild nosebleed that has stopped bleeding does not require any treatment
  • If the site of the bleeding is from a blood vessel that is visible, the doctor will cauterize (freeze the blood vessel) with a chemical called silver nitrate. This process is called Chemical cauterization.
  • In more severe cases, a nasal packing may be needed to stop the bleeding.